Thursday, 21 February 2019

Adelusi-Adeluyi To Address Executive Dialogue On Ecomony, Pharmacy Growth

Prince Julius Adelusi-Adeluyi, former Nigerian Minister of Health and president of the Nigeria Academy of Pharmacy, is billed to address an Executive Dialogue on Public and Private Sector Collaboration for Economic Growth in the Pharmaceutical Sector. This dialogue will hold in Sandton, South Africa, on February 14.
Prince Adelusi-Adeluyi who is also the founder and Chairman of Juli PLC will speak on “Solutions and measures to combat counterfeit medicines”. The problem of fake and counterfeit medicines has plagued Nigeria and many developing countries for decades.
According to Adelusi-Adeluyi, “the problem of fake and counterfeit medicines has grown increasingly complex over the years and only a multi-pronged approach that has both the private and public sectors acting in concert is best placed to address it effectively.” He added that “an executive dialogue of this nature that seeks to inspire multi-sector collaboration, therefore, is clearly in the right direction as the plague of fake and counterfeit medicines impacts considerably on the economic growth of the pharmaceutical industry.”
Other speakers expected to grace the high level Executive Dialogue include Professor Helen Reese, Chair of the South African Health Products Regulatory Authority, Ms. Precious Matsoso, Director General of the South African Department of Health, Dr. Timothy Kedijang, Chairperson of the Pharmaceutical Industry Association of South Africa,Dr. GustaafWolvaardt, Managing Director of the Foundation of Professional Development among many others.
The Executive Dialogue, by bringing experts from both the public and private sectors together is expected to unravel key policy approaches that will facilitate more result-oriented collaboration between governments at different level and the extended pharmaceutical value chain. Policy proposals arising from the discourse will be made available to national governments in key emerging markets.
The Executive Dialogue is organized by Inspirational Development Group of South Africa in association with the Foundation for Professional Development.

Index Case Finding, A New Way To Identify Adolescents With HIV

Chioma Umeha

Research has shown that knowing one’s HIV status can help in making healthy decisions to prevent acquiring or transmitting the Human Immune Virus (HIV).
Nigeria is home to 10 per cent of Adolescents Living With HIV(ALHIV) globally, that is about 240,000, according to a project initiated in response to the 2016 National Adolescents and Young Peoples (AYP) HIV strategy.
However, this number is not reflected in HIV Testing Services (HTS) and Antiretroviral Therapy (ART) services, hence the need to identify Adolescents Living With HIV and put them on treatment.
To this effect, a new study seeks to find adolescents living with HIV, link them to treatment, and ensure they remain in treatment.
It also seeks to observe and document factors that facilitate successful scale - up in identification and treatment of AYP living with HIV in service programmes in three States in Nigeria including, Lagos State.
However, the study uses family-based and index case finding approaches as an entry point to identify AYP aged from 10 to 24 years.
The methods include family attending HIV treatment sites, support groups as well as Orphan and Vulnerable Children’s (OVC) programmes.
These approaches involved determining HIV prevalence of persons from age 10 to 24 recruited through family attending treatment and support sites.
It further entailed ascertaining predictive factors for identifying AYP living with HIV who were recruited through family attending HIV treatment and support sites within Lagos State.
The review of the study carried out with the support of Lagos State Aids Control Agency (LSACA) in collaboration with Positive Action for Treatment Access (PATA) and United Nations Children’s Fund (UNICEF) in Lagos was a major agenda recently, in the state.
The review was aimed at intensifying HIV response for adolescents and young people in the state.
Speaking at the event, Mrs. Victoria Isiramen, UNICEF HIV Specialist said, “Young people are the present, and we need to engage them. Many say it is not easy finding young people; maybe because they do not come out.
“The index finding is a way of identifying adolescents with this virus and putting them on treatment. This work was done in Benue, Federal Capital Territory and now Lagos.
“UNAIDS believes that our children should be born free and live free of HIV, and we at UNICEF promise to give in our best.”
Isiramen said, “It has identified that we have more females with this virus than males.The partnership keeps HIV response for adolescents and young people (AYP) in focus and together we can find and save adolescents and young people living with HIV.What we are doing is to ensure that the AYP have a friendly and welcoming service so as to keep preventing this ailment.”
Giving the breakdown of the index case she said; “8525 index cases were identified; 105 known positives; 42 per cent aged between 10 and14-years-old tested positive; 10156 adolescents and young people traced and tested; 36 per cent adolescents and young people tested positive.
She added that 50 per cent aged 10-14 years tested positive and 8 percent adolescents and young people aged 20-24 years tested positive.
The UNICEF HIV Specialist said the index adult cases were identified through support groups and anti retroviral clinics located in public health facilities.
She said while the index sibling cases were identified through the ART clinics and, Orphan and Vulnerable Children (OVC) programmes run by non-government organisations located in Lagos State.
Isiramen said that the index-case finding tool was used to collect details of children and AYP in the care of the index adults and index siblings.
She however said that the National Client Intake Form was administered to children and AYP identified through the index cases that were tested for HIV through this project, adding that a questionnaire was also administered to the AYP identified, to assess their socio-demographic information, sexual behaviour and practices.
According to her, “Data collection was monitored to assure quality. Data was analysed to determine the HIV sero-discordancy rate; differences in HIV sexual risk behaviour and practices of HIV-positive and HIV-negative AYP; and predictors for HIV positivity.
“Ethical clearance of the study was obtained from the Nigeria Institute of Medical Research Institutional Review Board.”
Making his presentation, Isaac Moses in a Project Review of PATA said, “It was found that index case finding was more efficient for recruiting children and younger adolescents than older adolescents and young persons.
“That the approach increased the number and proportion of AYP accessing HIV testing and ART services at facilities. A large proportion of children and siblings 57.3 per cent of index cases did not know their HIV status.”
Moses said 36 HIV positive AYP were identified, equally spread between males and females.
He said, study also found a proportion of wards/children of index cases practicing unprotected vaginal sexual intercourse.
Significantly, he said, more HIV-positive than HIV-negative AYP use condoms during vaginal sexual intercourse.
Moses said “the highest rates of HIV positivity yield was found within the AYP aged 10-14 year-old: 42 percent. In the overall study, as high as 5.7 per cent of HIV-negative AYP are eligible for Pre -exposure Prophylaxis, (PrEP).”
On recommendations, Moses said the study posits that index case finding through family approach is an efficient way of generating high yield rates for HIV testing for AYP.
He said that targeted HIV testing of AYPs who are married, have a positive history of sexually transmitted infection, symptoms of tuberculosis, and or are aged 20-24-year-olds will likely yield high HIV positivity rates.
He states, “When index case finding approach is to be used; recruitment of the first to fourth children of index cases will likely yield more HIV positivity cases.
“Access to pre-exposure prophylaxis (PrEP) needs to be prioritised for sexually active HIV-negative AYP.
“Studies need to be conducted to learn how to best reach HIV-positive AYP through messaging on protected sexual intercourse, the value of accessible treatment, viral suppression, and non-transmission of HIV infection.”
Studies should include filter questions, as non-respondents to questions on age of sexual debut and history of sexual intercourse are more likely to have high risk sexual behaviour, a history of sexual assault or be HIV positive, he explained.

Improving Maternal Care Through Health Insurance

Nursing and pregnant women waiting to receive care at  Agbongbon Primary Health Centre, Ibadan Oyo State, recently.

Efforts to reduce out-of-pocket payments for healthcare, a huge burden on households and individuals remain a mirage in view of the poverty level of Nigerians which is put at 70 per cent. However, health insurance provides financial protection for pregnant women, spreading risks and pooling funds which would make maternal healthcare affordable and accessible, writes CHIOMA UMEHA.

Every day, Nigeria loses about 145 women of childbearing age, making her the second largest contributor to the maternal mortality rate in the world, according to United Nations Children’s Fund (UNICEF). When this statistic was released in 2017, it generated different responses from different people even as many disputed the figure.
Though pregnancy and child birth supposed to be safe and normal, so many women and their new born die due to pregnancy and child birth related reasons, those who survive end up with complications. Here lies the need to increase access of antenatal care for pregnant women.
Antenatal care, also known as prenatal care, is a type of preventive healthcare. The goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child.
Despite that antenatal care increases the chances of the survival of mothers and babies, the cost of accessing the ‘life-saving’ procedure makes it unaffordable to many poor families in the country. While some pregnant women resort to accessing care from unskilled attendants, some deliberately request family members to take the delivery evade payment of antenatal care from skilled attendants in health facilities.
Research has also shown that why many poor women and their families shun antenatal care is due to out-of-pocket payment, a barrier to accessing healthcare globally.
To tackle the issue of out-of-pocket payment and remove the  barrier it poses to many poor pregnant women from accessing antenatal care, the Oyo State Government recently initiated what it tagged, the Oyo State Health Insurance Agency (OYSHIA). This may be just a measure from the south west; it
OYSHIA intervention is in line with the global strategy to achieve Universal Health Coverage (UHC).
The UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services do not expose the user to financial hardship.
At least half of the world’s population still do not have full coverage of essential health services and based on this, all United Nations (UN) member states have agreed to try to achieve UHC by 2030, as part of the Sustainable Development Goals (SDGs).
It was on this basis that the National Health Insurance Scheme (NHIS) established under Act 35 of 1999, was established by the Federal Government to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems. However, 14 years after, less than five per cent of Nigerians are covered by NHIS.
OYSHIA, established 18 months ago is improving health service utilisation and providing financial protection against huge medical bills, according to Dr. Olusola Akande, its Executive Secretary.
He explained that the scheme in Oyo State would protect citizens of Oyo State from financial hazard, spreads the risk among every enrolee, pool the resources and consequently make it available to enrolees that become ill and need treatment.
The good news about OYSHIA is that the services have been made compulsory for all citizens of Oyo State. Akande, said the scheme was targeting 450,000 residents of the state with two per cent of its consolidated fund from the state internal revenue.
In less than two years, the scheme is reported to have made remarkable achievements, which includes over 80,000 enrolees from 33 local government areas (LGAs), 350 vaginal deliveries and 78 caesarian sessions, over 10,000 children under five years and pregnant women covered, creating employment opportunities for residents, upgrading three fully accredited PHCs and seven others at various stages of completion, as well as institutionalisation of engagement platforms for various stakeholders.
The need to use the services from OYSHIA to bridge the gap created by the out-of-pocket payment by pregnant women cannot be over-emphasised in view of the state’s infant mortality rate.
Dr. Adebola O. Hassan, UNICEF’s Health Specialist, said Oyo State is the third largest contributor of new born mortality rate in the whole of the south west.
Explaining why new born in the state were dying, she said although, there was a total of 33 LGAs and 351 wards in the state, overwhelming majority of the nurses and midwives were in urban LGAs and there was no single doctor in three LGAs: Egbeda, Ona Ara, Ogo Oluwa.
Also, she lamented that many citizens demonstrated poor health seeking behaviour, facility utilisation rate for children under five years across all LGAs, adding that only 10 LGAs have more than one per cent utilisation rate.
With the introduction of OYSHIA, Hassan said access to healthcare would be made convenient for citizens because of the method of payment. Apart from making the services mandatory for citizens, accessing health care is also perceived as the human right of people in Oyo State.
Akande further said 100,000 civil servants had been captured, but regretted that despite the success so far, there were still challenges such as negative beliefs, attitudes and customs of people on insurance policies, adverse selection and attitude of health-workers.
Other challenges are enrollees, subsidy and cross-subsidy for the vulnerable groups and the poor, limited resources for advocacy, inadequate and untrained manpower logistics and publicity and enlightenment.
He disclosed that even farmers and others who cannot afford to pay the N8, 000 were encouraged to pay with their farm produce to the agency in lieu of cash. “Many people who would have loved to enrol in our health insurance programme, but lack the financial capacity to pay the premium voluntarily agreed to give us yams and palm oil and other farm produce in lieu of cash to be paid for the premium,” he said.
“In the agency, we have set up a marketing section that is helping us to sell the yams and palm oil and other farm produce and when we sell them, we help the owners to keep the money until it is enough to pay the premium and enrol them.”
Akande said the goal of health insurance was to provide quality healthcare services for the people of the state without experiencing catastrophic health expenditure. Regretting that many people were still not aware of the activities of OYSHIA, he encouraged the media to support the initiative and boost enrolees by creating awareness on the importance of health insurance.

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