POVERTY

I would like to thank the organisers of this convention for this opportunity to share my thoughts on the issue of health services and the state of health of the people of Edo State so that we may proffer solutions on how the situation can be improved. As there is more than one speaker dealing with the issue of health, I would try to limit myself to the health of women and children and occasionally dabble into health for all.
The WHO’s Constitution defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Let us limit ourselves to the aspect that stated ‘’ social wellbeing’’ What is social wellbeing?
The synonyms for social include collective, shared, communal, community, societal and common. Whereas the synonyms for wellbeing include security, safety, health, comfort and happiness.
Social wellbeing therefore implies collective, communal or community safety or security or health or comfort. You know, and I know and we all know that these are rare features amongst our people especially our women and children in Edo State and Nigeria.
Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Good health can be favoured by political and economic policies, social, cultural, environmental, as well as behavioural and biological factors.
The reverse is also true. If economic, social and political policies are poorly implemented or non implementation can be harmful to peoples’ health. The numerous civil wars in sub-Saharan Africa, poor governanceof the people, selfish and inoperable governmental policies, non payment
of salaries all add to the woes of the poor state of health of our people.
The Health Woes
To see how poor in health we are, compare the actuarial calculation of life
expectancy for Nigeria, which is 48 years with that of the UK, which is 81
and 84 for the women. Yet we are living in the same world. Are we really?
MATERNITY CARE AND DEATH IN INFANCY.
The fertility rate in Nigeria is 6.4 one of the highest in the world but note
that nearly fifty percent of the children will die before their 5th birthday.
That is colossal loss of human lives. It is only in sub-Saharan Africa you
will hear of women who have been pregnant 17 times, has had eleven
babies with only two children alive. She is not only psychologically
traumatised due to the loss of her babies from poor and inadequate
health services in addition to her lack of proper education, her blood level
will be low, her womb is likely to be dropping down from below, she is
likely to wet herself when she passes urine, and she is completely washed
from breast feeding her babies and looking after her husband. If she is
unlucky to be leaking urine continuously then she will be a social outcast.
This is the picture of the extreme of the spectrum for some of the women,
but in this desert of abject poverty and wants, there are oasis of affluence
where women can afford to come to Europe to have their babies in the
best maternity units that Europe can provide.
When you compare the neonatal mortality rate of 105 per thousand live
births in Nigeria (UBTH 33/1000 in 1987) with that of the UK where the
neonatal mortality is 8/1000 live births you will not blame these women.
The cost of flight of a pregnant woman and her husband flying from Abuja
to London is five hundred thousand (500,000) naira, the delivery cost is
about six hundred thousand (600,000) naira equivalent in the local
currency and if a caesarean section is done, the cost will increase to about
eight hundred thousand (800,000) naira. When you add the husband’s
hotel bills as she can not stay in the wife’s room in the maternity unit and
other incidentals, the total cost will be about four million naira using a
conversion factor of 250naira to one pound. This huge amount can build
or equip a maternity unit in Benin with basic equipments or better still
pay the salaries of over 80 midwives for one year. Think of the number of
people that amount of money can feed in a year in Nigeria. You can see it
is not only the government that is to blame but we the people as well. We
need to set our priorities right. We need to throw away the concept of I
and start thinking of ‘us or we’
In sub-Saharan Africa the maternal mortality rate (number of women who
die in childbirth) is 920 per 100,000 live births. Compare to 24 per
100,000 in Europe. You will see the colossal waste of human lives? Thetotal number of maternal deaths in Nigeria in the year 2000 was 37,000.
Nigeria came second in the whole world to India with 167,000 maternal
deaths, but note that the population of India is over one billion people. If
the figure is adjusted for population then Nigeria will have the highest
maternal death per population in the whole world. These women do not
come from outer space. They are our wives, your sisters, our mothers.
This is a huge problem the government does not want people to know
about.
ILLEGAL ABORTIONS
What about the woes from unsafe abortions by which I mean abortion not
provided through approved facilities and/or persons” This is classified as
illegal abortions in Nigeria. As abortion is not legalised, there is a thriving
back room, backdoor and backstreet abortions in the population. Death
from illegal abortions accounted for 13% of the total maternal deaths in
Nigeria in the year 2000. This percentage translated into 4800 deaths
amongst our daughters and wives in Nigeria in the year 2000. You will all
agree that a lot of the deaths will go unrecorded. So this number of
deaths is actually the tip of the iceberg as it is a more serious problem.
What about those that are maimed for life, what about those that will
never be able to fulfil the normal biological process of pregnancy, labour
and delivery as a result of the sequelae due to procuring illegal abortions.
The psychological trauma and abnormal grief reaction in such women can
only be imagined The list of woes is endless.
ILL HEALTH AND DEATHS FROM ARMED ROBBERY.
Social wellbeing equates to safety and security of the community. Look at
the incidence of armed robbery and burglary in Nigeria. When have our
people gone to bed and hope to wake up the following morning. What
about the psychological trauma of being visited by an armed robber?
What about the financial cost of erecting high walls and fences, the
numerous protectors in our homes which becomes hazardous in fire out
break in the homes, the guard in the gatehouse all are drain on our
resources. In the UK the windows and doors are made of glass and you
can be sure to sleep till morning without rude awakening from a night
marauders.
You all can recall the recent killing of seven Hausa foreign exchange
traders in Benin in May 2004 and the raiding of a whole street off
Akpakpava Road eleven days later, and all the daily armed robbery
activities our people have been made accustomed to, all in broad
daylight. The robbers usually get away, if they are ever caught, it is not
reported. Such dramatic events affect the psyche of the people thus
contributing to ill health.DEATH AND INJURY FROM ROAD TRAFFIC ACCIDENTS.
During the WHO celebration in April 2004, the global campaign
was launched to prevent road traffic accidents, they noted that
the highest number of deaths due to RTA occurred in Nigeria in
the preceding year. There is more than 50% chance that one will
not get to the destination when travelling on a Nigerian road.
Accidents, injuries and violence are common place.
Travellers are more likely to be killed or injured in accidents or through
violence than to be struck down by an exotic infectious disease. Traffic
accidents and violence are significant risks in many states in Nigeria
especially Edo State, where skilled medical care may not be readily
available. No ambulance services, no incident support systems of any
sort. A helipad was built in UBTH accident and emergency unit for quick
recovery of accidents victims along the busy and accident prone
Benin/Lagos Road. Thirty years on, it is still not operational. The question
is not good intentions but lack of the will for implementation of our plans.
The plans just die on the drawing board. Usually those awarding the
contract take ten percent of the total cost, the contractors take ten
percent of what is left, the sub-contractors take another ten percent and
by the time the project is executed by the daily paid workers even with
the use of substandard equipment, the fund is inadequate for the
completion of the job hence the numerous abandoned projects that litter
the landscape of our country.
It is estimated that more than 1 million people were killed in traffic
accidents worldwide in 1998 and a further 10 million were injured and the
majority were from many developing countries like Nigeria. In Edo State
for example traffic laws are limited or are inadequately enforced. Our
people are even part of the problem because they have been seen
removing traffic light bulbs in broad day light unchallenged. People do not
care about the traffic ordinance because if caught they will easily bribe
their ways out of punishment. Often the traffic mix is more complex than
that in developed countries and involves two wheel(push trucks) and four-
wheeled vehicles, animal-drawn vehicles and other conveyances, plus
pedestrians, all sharing the same road space. The roads may be poorly
constructed, poorly maintained, road signs and lighting inadequate and
driving habits are usually poor.
DEATHS FROM HIV/AIDS, MALARIA other Infections and infestations.
About 90% of all malaria deaths in the world today occur in Africa south
of the Sahara. This is because the majority of infections in Africa are
caused by Plasmodium falciparum, the most dangerous of the four human
malaria parasites. It is also because the most effective malaria vector -the mosquito Anopheles gambiae – is the most widespread in Africa and
the most difficult to control. An estimated one million people in Africa die
from malaria each year and most of these are children under 5 years old
There are three principal ways in which malaria can contribute to death
.in young children First, an overwhelming acute infection, which
frequently presents as seizures or coma (cerebral malaria), may kill a
child directly and quickly. Second, repeated malaria infections contribute
to the development of severe anaemia, which substantially increases the
risk of death. Third, low birth weight – frequently the consequence of
malaria infection in pregnant women – is the major risk factor for death in
the first month of life
In addition, repeated malaria infections make young children more
susceptible to other common childhood illnesses, such as diarrhoea and
respiratory infections, and thus contribute indirectly to mortality
Poor people are at increased risk both of becoming infested with malaria
and of becoming infected more frequently. Child mortality rates are
known to be higher in poorer households and malaria is responsible for a
substantial proportion of these deaths. In a demographic surveillance
system in rural areas of the United Republic of Tanzania, under-5
mortality following acute fever (much of which would be expected to be
due to malaria) was 39% higher in the poorest socio-economic group than
in the richest.
Nigeria now has a national HIV prevalence rate of 5.8% and a population
of 3.01 million adults who are living with HIV/AIDS. The country is
currently embarking on a “Care” project – to provide Anti Retro Viral
(ARV) treatment for 10,000 adults and 5,000 children, at a cost of about
three hundred and fifty million naira (over US$3 million). The UBTH in
Benin City is one of the Centres of Excellence for the treatment of
HIV/AIDS in Nigeria and their current prevalence rate is very similar to
the above figure. You must note these are hospital based figures and the
scale of the problem in the population will be more serious as many of
deaths from HIV/AIDS go unreported.
OTHER DISEASE CONDITIONS:
Under this heading I will include diseases like hypertensive heart diseases
and stroke, diabetes mellitus, other deficiency diseases like
hypothyroidism, the cancers, obesity, illnesses related to stress and
lifestyle which are not communicable. About 10% of the urban population
have hypertension and diabetes is estimated in 2.7% of the population of
Nigeria.
The above disease conditions may result mostly from having too much to
eat, too much to drink, too much to smoke, too much worries associatedwith too much wealth, too many women and too much sex, so I shall not
consider them any further especially as they account for a very small
percentage of death in our population.
THE SOLUTIONS TO THE HEALTH PROBLEMS.
The most important solution is free, universal and compulsory education
from the cradle to the grave. This is a policy of the present
administration. Is it being implemented to the grassroots level? That is
the question. Go along Uselu -Lagos Road and Ring Road in Benin City
and you will see hundreds of under 16 years old, both male and female
hawking pure water, bread, handkerchief, hawking any ware in search of
clean money to help their parents put bread on the table when they
should be in school learning. In later life, they constitute fertile ground for
recruiting hoodlums who do anything for money.
Gainful employment
It is the duty of any government to reduce unemployment figures. In
Nigeria and Edo State such figures does not exist therefore reducing
unemployment is out of the question. The government both state and
federal is not assisting in providing the required enabling environment
where economic development and private finance initiative will thrive.
If the jobless are employed or engaged in agro based industries as land is
plentiful in Edo State, the crime rate will drop and more people will be
energized into investing in Edo State economy. This will build in a
spiralling momentum of economic development that can make Edo State
the food basket of the Nation.
The security situation is worsened by the attitude of our people by no
longer being there for one another. What has happened to the collective
responsibility of yesteryears when our parents mounted guard (night
watch or Ude)? What about when our fathers flushed out jobless but
flamboyant and affluent people in our communities as suspected thieves
and robbers? What has happened to the street security meetings and
activities in all areas of Edo Land? The government of the day and police
must lead the way in bringing safety back to Edo State. We have done
this before. We can do it again. But to rely solely on the police or the paid
night watchman without involvement of everybody is to fail dismally.
HIV/AIDSThe prevention and care of HIV/AIDS and sexually transmitted infections
(STI) should be part of reproductive health programmes at all levels
including primary health care.
The management of pregnancy in HIV-positive women should be seen as
part of the comprehensive and long-term care of the woman provided to
her at settings within easy reach of her home.
Obstetric management will be similar to that for uninfected women (or
women of unknown sero status) in most instances, although invasive
diagnostic procedures should be avoided, and iron folate and other
vitamin supplementation should be considered. In areas of high
prevalence, these procedures should be for all pregnant women.
HIV testing in pregnancy has a number of benefits in terms of prevention
and care for mother and child but this must be balanced against the
possible risks of stigmatisation, discrimination and violence. In order to
avoid or minimize negative consequences, testing must be voluntary and
confidential and accompanied by quality counselling.
The slogan to prevent or reduce the incidence of HIV should include
Abstinence.
Sex education.
Stable monogamous setting.
Improvement on the socio-economic status of the population.
There is nothing like safe sex so do not expose yourself.
The high mortality from HIV/AIDS in sub-Saharan Africa is complicated
with the poor socio-economic status of the people. Poverty leads to sub-
optimal innate immunity resulting from poor or inadequate nutrition or
malnutrition and poor general health, which increase susceptibility to
infection. Poverty makes the purchase of anti-retroviral drugs impossible
and in certain situations when the drugs are available there is no portable
water to assist in taking the medications. HIV/AIDS infection is therefore
a death sentence in places like Nigeria and Edo State in particular
whereas in Europe and America for example those diagnosed with
HIV/AIDS still live active, normal lives and some of them are gainfully
employed and may remain so for over twenty years after such diagnosis
due to the care and social support they receive.
Health PromotionThere is need for health promotion which in a country like Nigeria and in
Edo State in particular, should be the process of enabling people to
increase control over, and to improve, their health. To reach a state of
complete physical mental and social wellbeing, an individual or group
must be able to identify and to realize aspirations, to satisfy needs, and to
change or cope with the environment. Health is, therefore, seen as a
resource for everyday life, not the objective of living. Health is a positive
concept emphasizing social and personal resources, as well as physical
capacities.
Prerequisites for health
According to the WHO, the fundamental conditions and resources for
health are social security, peace, shelter, education, food, income,
sustainable resources, social justice and equity and I will add portable
water. It is impossible to swallow tablets without water. Lack or
inadequate water supply and poor sanitation contribute immensely to
easy death and poor recovery from mild infections. Therefore
improvement in health requires a secure foundation in these basic
prerequisites like available and safe water supply and good sanitation.
The prerequisites and prospects for health cannot be ensured by the
health sector alone. More importantly, health promotion demands
coordinated action by all concerned: by governments, by health and other
social and economic sectors, by non governmental and voluntary
organizations, by local authorities, by industry and by the media. People
in all walks of life should be involved as individuals, families and
communities. Professional and social groups and health personnel have a
major responsibility to mediate between differing interests in society for
the pursuit of health.
Health promotion goes beyond health care. It puts health on the agenda
of policy-makers in all sectors and at all levels, directing them to be
aware of the health consequences of their decisions and to accept their
responsibilities for health.
Health promotion policy combines diverse but complementary approaches
including legislation, fiscal measures, taxation and organizational change.
It is coordinated action that leads to health, income and social policies
that foster greater equity. Joint action contributes to ensuring safer and
healthier goods and services, healthier public services, and cleaner, more
enjoyable environments.
Health promotion policy requires the identification of obstacles to the
adoption of healthy public policies in non-health sectors, and ways of
removing them. The aim must be to make the healthier choice the easier
choice for policy-makers as well.Strengthen community action
Health promotion works through concrete and effective community action
in setting priorities, making decisions, planning strategies and
implementing them to achieve better health. At the heart of this process
is the empowerment of communities, their ownership and control of their
own endeavours and destinies.
Community development draws on existing human and material resources
in the community to enhance self-help and social support, and to develop
flexible systems for strengthening public participation and direction of
health matters. This requires full and continuous access to information,
learning opportunities for health, as well as funding support. The
organisers of the sanitation crusade going on in Benin City presently
should be advised against the use of poorly trained or corrupt officers as
their action is causing unnecessary stress, aggravation and therefore ill-
health amongst the people.
Enabling people to learn throughout life, to prepare themselves for all of
its stages and to cope with chronic illness and injuries is essential. This
has to be facilitated in school, home; work places and community settings
like the palaces of traditional rulers and market places. Action is required
through educational, professional, commercial and voluntary bodies, and
within the institutions themselves.
Reorient health services
The responsibility for health promotion in health services is shared among
individuals, community groups, health professionals, health service
institutions and governments. They must work together towards a health
care system which contributes to the pursuit of health.
The role of the health sector must move increasingly in a health
promotion direction, beyond its responsibility for providing clinical and
curative services. Health services need to embrace an expanded mandate
which is sensitive and respects cultural needs. This mandate should
support the needs of individuals and communities for a healthier life, and
open channels between the health sector and broader social, political,
economic and physical environmental components.
Reorienting health services also requires stronger attention to health
research as well as changes in professional education and training. This
must lead to a change of attitude and organization of health services,
which refocuses on the total needs of the individual as a whole person.
Caring, holism and ecology are essential issues in developing strategies
for health promotion. Therefore, those involved should take as a guiding
principle that, in each phase of planning, implementation and evaluationof health promotion activities, women and men should become equal
partners and money meant for health should be spent for healthcare and
not diverted to other areas or worse still to private Swiss Banks accounts.
Commitment to health promotion
Will you pledge as you go back to Benin City to support youth clubs and
organization like Boys Scouts, Girls Guide, Red Cross, Youth Sports,
Community Organizations so as to take the minds of our youths away
from crimes as an idle mind is the devil’s workshop.
Will you as leaders lead by examples by sharing and exhibiting live and
let live attitude instead of flaunting your wealth to the annoyance of the
poor and those in need. Most times our attitudes and behaviour is an
invitation to armed robbery, which is avoidable.
Will you encourage moral re- armament and religious instructions in
schools? This is something the State government is experimenting with by
reverting the schools to the missionaries. This will help in producing
children with high moral standards and reverse the current evil trend of
worship of money rather than striving for honour as was prevalent and
the norm in my school days.
Will you go home and give voice to the voiceless. Help the poor, support
the infirmed, and help to translate our discussions into reality. Do not be
complacent. Start from your family. If you make your family good, you
make the community better; if the community is good, we have a better
town, and if the town is good, we shall have a better State; and if the
State is good, we shall have a better Nigeria which will support a better
world, making our lives a lot better.
The provision of good sanitation, safe water supply, good roads,
emergency team, social security for the unemployed, prevention of floods
by adequate planning and execution of contracts for road building,
security for life and property will all help in improving the general health
of our people. This is a tall order but it is possible if our people are
motivated and mobilized with those at the helm of affairs leading by
example.
SEO OGBONMWAN, JULY 2004, BOSTON MASSACHUSETTS, USA.REFERENCES. 1,http://www.afro.who.int/country_offices_press/2002/pr20020312.htm 2,The World Health Report 2002: reducing risks, promoting healthy life. Geneva,
3, World Health Organization, 2002Molineaux L. Malaria and mortality: some epidemiological considerations. Annals of Tropical Medicine and Parasitology, 1997, 91(7):811-825
4, Nigeria Reproductive Services and Manpower Survey (2001) Reproductive Health Division, Federal Ministry of Health, Abuja Nigeria.
5, Health Systems Development Project 11, Federal Ministry of Health, Abuja 1989. 6, Federal Ministry of Health, NHMIS (Preliminary Health Profile Figures) 1999.

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