University of Nigeria College of Medicine Accreditation Saga: “Henceforth We Will Avoid Similar Embarrassment”, Assures Professor Onwubere

Professor Basden Onwubere, Provost University of Nigeria College of Medicine, Ozara-Ituku

When the University of Nigeria College of Medicine (UNCOM) among 8 other institutions, briefly lost its accreditation with the Medical and Dental Council of Nigeria (MDCN) in 2011, many of its students, faculty, and alumni bristled with anger at the perceived incompetence of the college authorities. The MDCN decision led other accrediting bodies, such as the UK’s General Medical Council (GMC) to withdraw their recognition too. As a consequence, many alumni of the affected schools, some of them highly accomplished in their respective fields of medicine, felt a sense of betrayal and embarrassment. Here at The ANPA Blog, UNCOM alumnus, Dr. Echezona Ezeanolue, an associate professor of pediatrics at the University of Nevada School of Medicine, wondered whether the standards of medical training had fallen such that so many institutions were affected. Another ANPA member and Treasurer of the Universitity of Nigeria College of Medicine Alumni Association (UNCOMAA) North America chapter, Dr. Tagbo Ekwonu, posted a thought-provoking piece rallying his fellow alumni to step up to rescue their alma mater. As he memorably stated “we are the ones we have been waiting for”, echoing Barack Obama’s inspirational appeal to Americans in the heady days of the 2008 campaign.

In response to Dr. Ekwonu’s piece, which was widely circulated among Nigerian diaspora physicians, and also published here, the UNCOM Provost, Professor Basden Onwubere, moved swiftly to quell the firestorm. He told ANPA members that this was a “very sad situation to me personally and the entire College staff and students”. Professor Onwubere, however, took umbrage at some of the criticisms being lobbed at his leadership and sought to “correct the impression being created that the suspension was because of ‘sub-standard training’”. The embattled Provost may appear defensive but is not ducking responsibility. He seems determined to contain the damage by reaching out to alumni groups. Displaying a sense of openness and accountability rarely found among leaders of troubled Nigerian institutions, Professor Onwubere told this Blog that he would willingly respond to any questions or comments, adding “it is, indeed, my responsibility as the current Chief Executive of our Medical Institution to provide accurate and current information on the state of affairs in that institution.”

The ANPA Blog followed up with Professor Onwubere, to seek his responses to several critical swipes that had been taken at the institution’s leadership in the wake of the accreditation saga (see here and here and here and here and here and here and here). We solicited questions from ANPA members and in particular UNCOM alumni in the US.

Below, we reproduce the first of my 2-part interview with UNCOM Provost, Professor Basden Onwubere.

Q: We understand that the principal reason for the loss of accreditation was the recurrent issue of excessive class size. To begin with, please give us the full context about the MDCN complaint. How many students is the college allowed and how many were admitted?

A: The admission quota granted to our Medical School by the Medical & Dental Council of Nigeria (MDCN) is 150 but for the past few years this quota had been exceeded. The MDCN benevolently pardoned all excesses prior to 2007/2008 academic session and also allowed 20% excess up to 2009/2010 academic year. The students are now being assigned index numbers in their second year by the MDCN which they will have as students and also throughout their practice.

Q: What led to the admission of more students than allowed by the MDCN?

A: Reasons usually mentioned for ‘over-stepping’ are pressures from Staff, Government officials etc. We are unable at this point in time provide further details. I sincerely believe the reasons are largely avoidable.

Q: Aside from the accreditation issue, is it not likely that too many students affect training and undermine the quality of education? Can the college’s training resources support more students than approved by the MDCN?

A: Obviously, admission quotas given by regulating Bodies (MDCN, NUC, etc) are based on available staff and teaching facilities in the Institutions being accredited. Exceeding bounds would certainly affect quality of education and this is why the Agencies like the MDCN wield their big hammers to discourage Institutions from flouting the rules. 

Q: Does the new campus at Ozara-Ituku have the capacity for a larger class size? In view of current projections for health workforce in your region of the country, is there any plan for an upward adjustment to match the anticipated need for a larger number of healthcare providers in the coming years?

A: The Ituku-Ozalla Campus has a large land mass and capable of absorbing any projected increase in number of healthcare providers. Already teaching aids are being installed there by the University like Google-assisted internet facility.

Q: Some people have alleged that college authorities yield to pressure from politicians and other powerful individuals to admit their relatives even when they are not the most qualified. Some allege that officials receive bribes in exchange for admission slots, and that these corrupt practices contributed to the bloated admission rolls. How do you respond to this?

A: The current admission process is not entirely a College affair. The issue of alleged corrupt practices hinges on legal issues that need to be investigated and appropriately handled. I personally believe that an officer of the status of a Dean, Provost or higher rank is expected to behave responsibly and my nature is to convince myself that such is the case.  I can assure you that efforts have been put in place to avoid the embarrassing situation our College found itself recently during the temporary suspension of accreditation.

To be continued.

Posted in Accreditation, education, ethics, MDCN, medical schools, UNCOM, UNCOMAA, universities | Leave a comment

A Tale of Two Health Systems

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, but that’s always how things are in Nigeria. Striking juxtapositions of polar opposites – wealth and abject poverty; intellectual brilliance and illiteracy; exemplary honesty and guiltless corruption – are part of everyday life and few feel the need to do anything about it. Folake is one of the few. Since she started medical school in 2008, she has focused on understanding health disparities and thinking about ways to eliminate them. She has plans for Nigeria and certainly has the drive to see them through. In June 2011 however, she broke up with her fiancé and temporarily lost much of her motivation to do well in school. After four months of depression and one suicide attempt, her parents decided to seek medical assistance and got her admitted to a private hospital in Ikeja, Lagos – one of the best private hospitals in the state.

At the hospital, Folake’s parents were informed that they had to pay a portion of the fees before they could receive any care. Luckily they are well off, having both had successful careers in the business industry. They paid with few complaints. Unfortunately, the hospital was not quite as ready to fulfill its part of the bargain. The family soon realized that when tests were ordered, they had to personally walk over to the laboratory to ensure that the appropriate studies were being performed. Worse still was the minimal patient monitoring that was provided at the hospital. The parents took turns watching their daughter because no one at the hospital had time to do it. One lapse in their surveillance efforts allowed another suicide attempt that left Folake with a broken arm. Disappointed with the private health sector, Folake’s family decided they would seek orthopedic care in the public sector, electing to pursue care at one of the National Orthopedic Hospitals. Through a friend of a friend, they were able to get their daughter admitted to the facility. Folake did not see a doctor until the third day of her admission. The family was then informed that the hospital’s x-ray machines were broken so any imaging studies would have to be done at a private facility, an hour away. At that point, Folake’s parents were so frustrated with Nigerian health care that they flew her out of the country. This option was only available because they could afford it.

A few thousand miles away in Chicago, Illinois, Stephanie was starting to have mood issues of her own. A week after losing her husband in a car accident, she visited her doctor who promptly committed her to the psychiatric ward of a nearby hospital. Somewhere in their discussion she admitted that at one point during the past week she had thought about hurting herself. A week, two MRIs and multiple lab studies later, the attending psychiatrist deemed her fit to leave, discharging her with prescriptions for anti-depressant medications. Fast-forward two months and things aren’t going well for our young widow. Without her husband, she is barely able to make ends meet. Then she gets the bills in the mail for her stay in the hospital. The responsibility for paying $7,600 in hospital fees is too much for her. She too decides to make an attempt to end her life…

That the structure of the health system (or lack thereof) played a part in the health outcomes of these two women is unquestionable. On the one hand, Nigeria’s total lack of healthcare regulation exposed Folake to the devices of incompetent health care providers whose efforts were directed at extorting money from the patient. On the other hand, the practice of defensive medicine that is now common place in the United States Health Sector led to bankruptcy and the sense of financial helpless that left Stephanie stranded. Perfection in the design of healthcare systems still eludes mankind, but some places do it better than others. Sick Around the World is an hour-long documentary that explores the features of different health care systems around the world. It’s a must see for anyone interested in working through the challenge of delivering healthcare at the national level. Policy makers and health care providers in Nigeria and in the United states can benefit from the insight provided in the video as we seek improve the way we take care of our citizens.

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ANPA Member Leads Team That Performs First Transcatheter Aortic Valve Replacement in the Carolinas

Yele Aluko MD, FACC, FSCAI, Interventional Cardiologist and Past ANPA President

On January 12, 2012 at Presbyterian Hospital in Charlotte North Carolina, ANPA member Dr. Yele Aluko led a team of physicians that successfully performed transcatheter aortic valve replacement in two patients with critical aortic stenosis.

Presbyterian Hospital was the first hospital in the Carolinas to perform the new, commercially-approved transcatheter aortic valve replacement (TAVR), a lifesaving procedure intended for patients not suited for surgery. This transformational technology was approved by the FDA in November 2011. Presbyterian became the first hospital in the Carolinas and one of the first in the country to perform this procedure after commercial approval and outside clinical trials.

This heart valve replacement is performed while the heart is beating and eliminates the need for traditional open-heart surgery. Together, an interventional cardiologist and cardiovascular surgeon create a small incision in the groin and feed a wire mesh valve through a catheter to the patient’s heart from the femoral artery.  Physicians and staff from Mid Carolina Cardiology  Hawthorne Cardiothoracic & Vascular Surgeons, Presbyterian Anesthesia Associates, Mecklenburg Radiology Associates, and cardiovascular nurses and staffcollaborated to perform this landmark procedure.

TAVR is appropriate for people with severe aortic stenosis, a narrowing of the heart valve that causes a restriction in blood flow to the heart.  Many patients with severe aortic stenosis cannot endure the traditional surgical approach of open-heart surgery for valve replacement due to age or coexisting health reasons.

Dr. Aluko, a past ANPA president, is an interventional cardiologist with Mid Carolina Cardiology and is Medical Director of the Cardiac Catheterization Laboratories at the Presbyterian Cardiovascular Institute in Charlotte, NC.

Posted in Cardiology, technology | 2 Comments

Nigeria One of Only 3 Countries With Endemic Polio

The World Health Organization (WHO) has long set its eyes on eradicating polio. Beginning in 1988, when it aimed for eradication by 2000, the target has seemed to move constantly. In the current Global Polio Eradication Initiative (GPEI), it is hoped that by the end of 2012 all wild poliovirus transmission will have ceased.

Milestone monitoring, mid-course corrections and strategic guidance for Polio Eradication (source: www. polioeradication.org)

Two decades ago, the goal to eradicate the stubborn disease seemed elusive to some, but mostly because among the counties with endemic polio was India, with thousands of cases being recorded and the population racing toward the 1 billion mark. But a year ago, a remarkable thing happened: India, became free of polio, and on January 13, 2013, it marked one full year without a new case being reported. Quite a feat for a country of 1.2 billion people and twice the population density of Nigeria.

Source: http://www.polioeradication.org

The eyes of the world now rests on the only 3 countries that still has endemic polio: Nigeria, Pakistan, and Afghanistan. In Nigeria, significant progress has been made, with the number of cases collapsing by more than 99% from 2009 to 2010. However, claims for the imminent eradication of polio in Nigeria has become a perennial headline news item. The temptation to declare premature victory was tempered by sobering news late last year of a four-fold increase in cases of polio in Nigeria (43 cases in 2011, versus 11 in 2010).

The bump in the road for the polio campaign in Nigeria has been linked to resistance by religious leaders in some parts of the country, who claimed that immunization was a Western plot to make people infertile.

Source: http://www.polioeradication.org

There remains much cause for optimism because, Nigeria’s leaders appear very intent on eliminating the crippling disease. President Goodluck Jonathan has increased the annual polio funding from N2.7 billion to N4.8 billion. Also, the current Minister of State in the Health Ministry, Dr Muhammad Ali Pate, has long been in the trenches fighting to eradicate the disease. On his part, the Health Minister, Professor Onyebuchi Chukwu, told The ANPA Blog that the administration is focused on full eradication by the end of 2012, and pointed to the recent launch of the Polio-Free Torch Campaign as the final push to ensure this goal is met.

Posted in Chukwu, health policy, Minister, Ministry, Pate, public health, vaccination, WHO | Leave a comment

ANPA Provides Technical Expertise for Curriculum Review for Nigerian Medical and Dental Schools

A group of physicians and dentists with expertise and interest in medical education selected from Nigerian and US medical schools are part of six Technical Working Groups (TWGs) assembled by the United States Agency for International Development (USAID) to produce a blueprint for the reform of medical and dental education in Nigeria.

From L-R: Dr. Fiemu Nwariaku, Dr. Vincent Idemyor, Dr. Christopher Okunseri, Dr. Igho Ofotokun, Dr. Echezona Ezeanolue, and Dr. Benedict Nwomeh

In response to an appeal by the Deans of Nigerian medical schools, the Association of Nigerian Physicians in the Americas (ANPA) secured the support of USAID to provide financial and logistical support for a comprehensive review of the curricula of Nigeria’s 36 medical schools. Several other Nigerian stakeholders are participating in the project, including the Federal Ministry of Health (FMOH), Medical and Dental Council of Nigeria (MDCN), and the National Universities Commission (NUC).

Many of these institutions currently utilize a version of the curriculum adapted from the original form introduced by the University College London, almost 60 years ago. To help Nigeria’s medical schools respond to the current health needs of the country, USAID’s Health Systems 20/20 Project is supporting the NUC, MDCN and FMOH through a series of activities to update the current undergraduate Medical and Dental curricula.

The goal is to create a platform that brings together relevant stakeholders to review existing literature and experience in utilizing medical curricula in Nigeria and around the world and thereafter produce a template that proposes a model on how medical education could meet the current needs of medical practice in Nigeria. According to USAID, “training health workers especially at the foundational level with the most up to date curricula for their local working environment is ……critical to health systems strengthening.”

The project, anticipated to be completed over a 2 year period began with initial meetings held in Abuja on March, 2011 and subsequently on December 13-14, 2011. Further meetings of the TWGs are planned in 2012.

ANPA has been represented by Fiemu Nwariaku, MD, Associate Professor of Surgery and Associate Dean of Global Health at the University of Texas-Southwestern, Dallas (President); Vincent Idemyor, MD, Professor of Medicine at the University of Illinois, Chicago; Christopher Okunseri, BDS, Associate Professor at the Marquette University School of Dentistry, Milwaukee;  Igho Ofotokun, MD, Assistant Professor of Medicine at Emory University, Atlanta; Echezona Ezeanolue, MD, MPH, Associate Professor of Pediatrics at the University of Nevada, Las Vegas; and Benedict Nwomeh, MD, MPH, Associate Professor of Surgery at The Ohio State University, Columbus.

Posted in education, MDCN, medical schools, NGOs, universities, USAID | Leave a comment

We are the ones we have been waiting for: An appeal to my Alumni

We are the ones we have been looking for“. The origin of this quote is debatable but President Obama has used it in his speech. The feminist movement has used it in their fight for equality. In the apartheid days in South Africa the freedom fighters used it to rally the troops.
I think it is appropriate in the University of Nigeria College of Medicine Alumni Association, North America (UNCOMAA-NA) executive committee campaign for help from the alumni.
• Graduates from the College of Medicine, University of Nigeria have been deemed ineligible to take PLAB because of substandard training.
• The College was also suspended by the accreditation board in Nigeria for the same reason.
• Transition of UNTH from Enugu to Ituku, Ozalla remains incomplete after the plan was started more than 30 years ago.
• More than 99% of grants for research and training from the US and other governments go through other Universities especially University of Ibadan and Lagos. At the recent ANPA convention in Chicago the College provost was present and was not aware of a research grant presented at the conference. University of Ibadan was listed as the agent for the grant which had already been implemented.
• The University of Nigeria continues to play an insignificant role as part of the Nigerian Higher Education Foundation and unlikely to benefit from the matching grant from the McArthur foundation.

As at January 1, 2012, most of the consultants and leaders at the College of Medicine and UNTH graduated in the past 30 years. Majority are Alumni of the College. We are responsible for the present status of the College. We are in a position to make things better. Is the College better off now than 30 years ago? The answer is a resounding no. I was asked to write a message on behalf of the 1989 class for the funeral brochure of Professor GC Ezeilo who passed away recently. I quoted the prof’s farewell message to the graduating class:

“My dear finalists, as you arrive at the end of a long journey, I wish you all complete success in your final MB.BS examination. You deserve it and God will be with you. I use this opportunity to offer some advice on your future careers as doctors.
Enjoy the fun of waking up as doctors and no more as medical students. The harsh realities of life in Nigeria of today will next hit you. You may not have a car; afford a decent hi fi system, shoes or clothing because your income will be a disappointment. Take solace from the knowledge that you are not alone and no doctor has yet died from poverty. Manage to dress like doctor; it inspires confidence. The learning process has just begun and the public does not expect you to know all. They expect you to know when to ask for a second opinion. As future professors and specialists, I expect you to perform better than we did. Finally, I sincerely wish all of you happy memories of your stay at the college of Medicine. You have had good training. Be our flag bearers

I took my PLAB examination without any hassles because the British General Medical Council believed I received good training from the College. Same as the USMLE and other examinations that has been the gateway for all the College graduates in the UK, USA and Canada. We have since moved on to become consultants, Professors and attending Physicians in our various fields. Unlike most of our American colleagues we have no college loans to repay. Believe it or not you received free education from the Nigerian government.
The Time magazine person of the year 2011 was the protester ranging from the Arab spring to occupy Wall Street. Occupy Wall Street was about the 99%. They are sick and tired of the 1% taking from them and never giving back or giving them the opportunity to get their share of the pie.
We are the 1%. We received good education that allowed us to take PLAB and USMLE examination. We received free education from the Nigerian government. We are the brain drain.

I am asking the Alumni to help revive UNCOMAA-NA and support the College of Medicine by doing the following:
• $200 dues to UNCOMAA-NA: PO Box 1280, Matthews, NC 28106.
• Donations to UNCOMMA-NA
• Starting a positive dialogue on how to make things better.
• Attending the next UNCOMAA-NA during the next ANPA convention in Las Vegas.
• Join the visiting lecturer series to interact with the students, Residents and Lecturers at the College.

I will like to thank those who paid their dues for 2011. It is now 2012 and I will ask you to make the same sacrifice and pay again for the year. I especially want to thank Dr. Ngozi Nwaneri (honorary alumni) for $1000 donation at the last UNCOMAA convention.
I apologize if I sound angry. I am not. I am tired of the apathy from the alumni and arm chair punditry about how bad things are in Nigeria and how it can be fixed.

This is the year 2012. No Knight in shining armor is coming to save us. We are the ones we have been waiting for.

Tagbo Ekwonu, MD
Treasurer, UNCOMAA-NA
Class of 1989

Posted in brain drain, charitable giving, diaspora, economy, education, medical schools, teaching hospitals, training, Uncategorized, universities | 1 Comment

On Cardiothoracic Surgery in Nigeria….

The complexities of cardiothoracic surgery are, simply put, mind blowing. It takes surgeons and anesthesiologists anywhere from two to eight hours to repair physiologic systems that are immediately responsible for the maintenance of human life. I just rounded up a cardiothoracic surgery elective at the Duke University Medical Center – needless to say, these guys are good. The technical skill of the surgeons left me drooling as I marveled at how comfortably they navigated through the bodies of other human beings. Even though I was occasionally allowed to help with the procedures, I always felt like a spectator watching an impeccably rehearsed rendition of a Mozart piece. Despite the thousands of years of residency/fellowship training, cardiothoracic surgery is now a serious career consideration for me.

Cardiac Surgery (digitaljournal.com)

As impressive – arguably more impressive – is the equipment required to make these operations possible. Cardiothoracic procedures incorporate state of the art technologies that to most are unavailable and/or expensive. Intricately linked to equipment is the issue of power. I’ll go out on a limb and say that the absence of a dependable power source is a contraindication to cardiothoracic surgery; any procedure would be an all-round horrible idea in the setting of full dependence on NEPA/PHCN. Considering these factors, the important concern is the feasibility of providing these services in Nigeria. For a surgeon in private practice, start-up costs would be humongous.  The public sector doesn’t seem to offer much promise either – Obtaining government support for a project of this magnitude would be, put mildly, painful.

It turns out however, that Nigeria already has some established programs in cardiothoracic surgery.  Although the University Of Nigeria Teaching Hospital (UNTH) in Enugu set the pace for the rest of the country (completing the first heart surgery on Nigerian soil in 1974), one of the leading initiatives today is provided through the Lagos state government at the Lagos State University Teaching Hospital (LASUTH) where surgeons have been performing heart surgery since 2004. A report in the Lagos Indicator Online  highlights that the project, started by Dr. Joe Nwilo from Atlanta, catered to 5 patients in its first year. Much of the initial expertise came from expatriate surgeons, but Nigerian providers have soon taken over. 58 heart surgeries have been completed at the center since 2006, including the first tube repair that was performed earlier this year. Although these numbers don’t quite match up to standards in some other parts of the world (at Duke, surgeons perform 3 – 4 cardiac surgeries every day), the effort is truly remarkable.

Cost, cost, cost…. where do I start? Even in Nigeria, cardiac surgery costs anywhere from $4000 to $9000, more money than many Nigerians make in their entire lifetimes. The Lagos state government (in collaboration with some local heart foundations) has done a great job funding some of these procedures, but it is clear that the current model is not sustainable. An interview in the Nigerian Journal of Health with Dr. Bode Falase – a LASUTH Cardiothoracic Surgeon and Senior Lecturer who currently heads the Cardiac Center – highlights the fact that program faces significant financial challenges. The interview – a quick but good read – highlights the need for Nigerian patronage for the survival of the program. Evidently, the program would benefit from a public enlightenment campaign if it is to attract wealthy Nigerians who are currently electing to travel abroad for their surgical needs. Public awareness is only one part of the solution. The economics of the operation must be modified to ensure that surgical costs appropriately reflect the financial climate in Nigeria. As some of the world’s fastest growing economies – in India and China – teach us, mass production maximizes efficiency. The health sector would not be the only beneficiary of a high output industry in healthcare technology. The jobs created, retention of health care consumers and potential for international trade would provide a strong stimulus for the Nigerian economy. I wonder what’s holding us back….

 

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UK’s General Medical Council Rejects Degrees from Some Nigerian Universities

Like a significant number of my classmates, I moved to the United States after graduating from University of Nigeria. I never felt unprepared during both my residency and fellowship training. I felt I had a good clinical experience while acknowledging my deficiencies in medical related technology like MRI, CT, etc. I felt it would be easy to acquire those skills which I did. Since I left medical school, most schools in Nigeria now have many of these technologies. So, I kept wondering if Nigerian medical schools are getting better or worse, are they getting better technologies but losing the basic concept of medicine? I know the UK made this decision after the accreditation of these institutions was suspended by the Nigerian Medical and Dental Council. There appear to have been various reasons for each institution being added to the list including admitting more students than the institution was accredited for (as the case with UNN). In some cases, it was the inability of the institution to respond in a timely manner to request from the accrediting bodies to address the identified shortfall that landed them on the list.

I will like to know what people think about these three questions

  1. Are standard of medical education in Nigeria dropping?
  2. Do you think increasing interaction of Nigerian medical school with Nigerian graduates in diaspora will be of any help?
  3. Any suggestions how diaspora physicians can help raise standard of training

The following medical schools are currently listed in the Avicenna Directory of medical schools but, at the present time, the GMC is not registering or issuing a licence to practise to graduates who hold primary medical qualifications obtained from those schools. Graduates from these schools are not permitted to make a booking for or to take the Professional and Linguistic Assessments Board (PLAB) test.

Nigeria

  1. Ambrose Ali University (this only applies to those who graduated after 10 December 2010)
  2. Ebonyi State University (this only applies to those who graduated after 10 December 2010)
  3. Igbinedion University College of Health Sciences (this applies only to those who graduated on or after 1 April 2010)
  4. Ladoke Akintola University of Technology (LAUTECH) (this only applies to those who graduated after 10 December 2010)
  5. Nnamdi Azikiwe University (this only applies to those who graduated after 10 December 2010)
  6. University of Benin (this applies only to those who graduated on or after 1 April 2010)
  7. University of Jos (this only applies to those who graduated after 10 December 2010)
  8. University of Nigeria (this only applies to those who graduated after 10 December 2010)
  9. University of Port Harcourt (this only applies to those who graduated after 10 December 2010)
Posted in Accreditation, License, medical schools, Uncategorized | Leave a comment

Corruption Threatens Future Funding for HIV/AIDS, Tuberculosis and Malaria in Nigeria

The Association of Nigerian Physicians in the Americas annual convention held in Abuja, Nigeria in the summer of 2009 provided an opportunity for many Nigerian physicians practising in the US to connect with their colleagues back home. On one of the evenings after scientific sessions were over, and it was time for pepper soup and beer, I gathered with some of my colleagues in the ultra expensive bar at the Transcorp Hilton Hotel. We had very lively discussions concerning how those of us practicing outside of Nigeria had abandoned the healthcare ship in Nigeria.

 It was during the discussion that I discussed my work in HIV and AIDS and the apparent ineptitude of the Nigerian government towards the prevention of HIV infection and transmission in Nigeria. I told some of my Nigeria-based colleagues that the Nigerian government and its agencies have not taken full advantage of international funding for HIV/AIDS and that when they have received grants the money has more often than not been mismanaged. One of my Nigeria-based colleagues who happen to work for the Ministry of Defense and manages the HIV/AIDS program took exception to what I said. I proceeded to give facts on how Nigeria had to return millions of dollars given to the country under the President’s Emergency Plan for AIDS Relief (PEPFAR) because the government and its agencies could not meet set deliverables. This is I said is unpardonable given the level of need for HIV prevention, treatment and care in Nigeria. After the first few years of PEPFAR, perceived corruption in recipient countries prompted the US government to institute a performance-based system with in-built deliverables. When benchmarks/objectives are not met, costs tied to such objectives are returned to PEPFAR.  This was foreign to many in Nigeria who will just pocket unused monies when projects are partly implemented or not implemented at all.

 The Nigeria Ministry of Defense that my Nigeria-based colleague works for and directs their HIV/AIDS program happens to be one of the recipients of PEPFAR funds. It was therefore not surprising to see him put up a big fight to defend the running of HIV/AIDS programs in the countries and that my assertions were untrue.

 I was doing my morning routine of catching up with Nigerian news before heading to work yesterday morning when I saw the headline in The Guardian Newspapers “Charges of fraud, controversies rock grants for AIDS, tuberculosis, and malaria.” This story on the mismanagement of grants from the Global Fund (full story at http://odili.net/news/source/2011/nov/9/4.html) not only confirmed my summer 2009 assertions in Abuja but paints the sorry state of ineptitude, outright corruption, irresponsibility, and recklessness on the part of the Nigerian government, its agencies and non-governmental agencies receiving grants for HIV/AIDS programs in Nigeria. It is sad that not only are we unable or unwilling to provide needed resources to combat the scourge of HIV/AIDS in Nigeria, we also mismanaging and stealing monies provided through grants by other countries who see the need to help us take care of our own. The non-governmental agencies, some of them not-for-profit that should serve as the conscience of the people including religious ones have joined governmental agencies known for corruption in lining their pockets with monie meant for improving the health of Nigerians. Nigerians here are double victims; victims of inadequate government funding for healthcare and victims of the siphoning and laundering of grants funds meant for providing preventin, treatment and care for them.

I wish I could see my Nigeria-based colleague who I met for first time during Abuja conference and ask him to look at me straight in face and repeat to me the statements he made in 2009 in the light of current revelations.

 Highlights of the report from the Office of the Inspector-General (OIG) of the Global Fund based on the Guardian report show that:

 * National Action Committee on HIV/AIDS in Nigeria (NACA) incurred extra-budgetary expenditures of $71,000, as well as $679,000 in unretired expenditures.

*    The Yakubu Gowon Center for International Cooperation (YGC), which had received four grants totaling $172 million. It is to refund to the Global Fund $5.2m, which could not be properly accounted for, and its financial activities would be further investigated by the OIG.

*    The Society for Family Health (SFH), at the end of 2009, had administrative charges of five per cent of the budget, amounting to $861,000 that was not accounted for, as well as $68,000 unretired expenditures.

*    The National Malaria Control Program (NMCP) had $711,000 unretired staff advances and $10,000 underfunded balance of rent grant. It is to refund $132,000, which could not be properly accounted for, or was not in the approved work plan and budget.

*    The Association for Reproductive and Family Health (ARFH) had $335,000 in management fees, which it could not justify, and could provide no accountability for.  It is to refund $504,000 it could not account for, or which was not in the approved work plan and budget.

*    The Christian Health Association of Nigeria (CHAN) illegally transferred foreign currency amounting to $11.6m to non-programme-related bank accounts abroad; the funds were later refunded into the local Naira bank account.  CHAN grant Sub-Recipients (SRs) had not accounted for $1.4million at the time of the audit, and CHAN is to refund $2.9 million which could not be adequately accounted for or which was not in the approved work plan or budget.

*    CHAN MEDIPHARM overcharged on distribution of products to the tune of $256,000; with $77,000 as unexpended amount on training.

The OIG said that “these transactions constitute high risk money laundering activity and pose a risk that grant funds were used in furtherance of underlying criminal activities perpetrated by third parties in country.”

Corruption has led to the suspension of Global Fund’s grants to Mali and the same might happen to Nigeria very soon. Cry my beloved country.

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ANPA 2012 Annual Meeting Date Announced

 

The ANPA 2012 Annual Meeting will be held July 5-7, 2012 at The Venetian / Palazzo Hotel Las Vegas. This three day meeting provides participant knowledge related to the challenges facing minority health care providers in the provision of clinical and therapeutic services for diseases and conditions related to a variety of medical specialties. The meeting will feature member lecturers providing state of the art technological advances that will impact the practice of medicine.

SAVE THE DATE and plan to JOIN US for next year’s event! Online registration begins in April 2012 at www.anpa.org

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