Let’s chat about Breastfeeding

(1st Published in Daily Trust Newspaper of Tuesday 26th August 2014)

“Dear Sir – I was surprized that the World Breastfeeding Week which was slated for 1-7 August 2014 came and gone without any word on this column. We look up to this column to create awareness and advocate for women and children issues. Was it that the topic wasn’t seen as ‘political health’ or it wasn’t important to you that for the entire week, not a word about it? Yours Sincerely J J”

This brief email letter from aggrieved reader and fan of this column has necessitated me to write some briefs about breastfeeding. All health issues are important but we need to be aware that sometime many issues emerge at the same time and one need to take a decision on what to write. It was true that the World Health Organisation (W.H.O) has assigned 1–7 August 2014 as the World Breastfeeding Week being celebrated every year in more than 170 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration signed in August 1990 by government policymakers, WHO, UNICEF and other organizations to protect, promote and support breastfeeding. Breastfeeding is the best way to provide infants with the nutrients they need. WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is six months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond.

Breastfeeding is one of the most effective ways to ensure child health and survival. “If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year. Globally, less than 40% of infants under six months of age are exclusively breastfed. Adequate breastfeeding counselling and support are essential for mothers and families to initiate and maintain optimal breastfeeding practices.”

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.

Simple Recommendations to ensure our children are well breastfed:

  1. WHO recommends exclusive breastfeeding for the first six months of life? At six months, solid foods, such as mashed fruits and vegetables, should be introduced to complement breastfeeding for up to two years or more. In addition: breastfeeding should begin within one hour of birth and breastfeeding should be “on demand”, as often as the child wants day and night; and bottles or pacifiers should be avoided.
  2. Health benefits for infants; Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies that help protect infants from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide.
  3. Benefits for mothers; Breastfeeding also benefits mothers. Exclusive breastfeeding is associated with a natural (though not fail-safe) method of birth control (98% protection in the first six months after birth). It reduces risks of breast and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster, and lowers rates of obesity.
  4. Long-term benefits for children; Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health. Adolescents and adults who were breastfed as babies are less likely to be overweight or obese. They are less likely to have type-2 diabetes and perform better in intelligence tests.
  5. Why not infant formula? Infant formula does not contain the antibodies found in breast milk. When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered formula.
  6. HIV and breastfeeding; An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and through breastfeeding. Antiretroviral (ARV) drugs given to either the mother or HIV-exposed infant reduces the risk of transmission. Together, breastfeeding and ARVs have the potential to significantly improve infants’ chances of surviving while remaining HIV uninfected.
  7. Support for mothers is essential; Breastfeeding has to be learned and many women encounter difficulties at the beginning. Nipple pain, and fear that there is not enough milk to sustain the baby are common. Health facilities that support breastfeeding by making trained breastfeeding counsellors available to new mother and encourage higher rates of the practice.
  8. Work and breastfeeding; Many mothers who return to work abandon breastfeeding partially or completely because they do not have sufficient time, or a place to breastfeed, express and store their milk. Mothers need a safe, clean and private place in or near their workplace to continue breastfeeding. Enabling conditions at work, such as paid maternity leave, part-time work arrangements, on-site crèches, facilities for expressing and storing breast milk, and breastfeeding breaks, can help.

These are simple recommendations that is expected to be shared and spread to all our mothers and breastfeeding support groups.

Aminu Magashi Garba is the Regional Lead for Africa Health Budget Network. Follow him @AminuMagashiG and @AHBNetwork and email healthweekly@yahoo.com



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500 Days Mark; Letter to President Goodluck Jonathan

(1st published in Daily Trust Newspaper of Tuesday 19th August 2014)

Your Excellency Sir; it is indeed one of our lowest moment in the health sector in Nigeria today. With the Federal Government of Nigeria sacking 16,000 resident doctors and suspending residency training as well as the on-going fierce battle of supremacy among health workers unions leaving out the “Patient” helpless and frustrated. In the light of these unfortunate development Monday, August 18th 2014 marks 500 days until the target date to achieve the Millennium Development Goals (MDGs). In 2000 via the United Nations, Nigeria promised that maternal deaths would decrease by 3/4, child deaths would decrease by 2/3 and there would be universal access to reproductive health.

As a partner of the Every Woman Every Child movement, survival rates for women and children around the world continue to be steadily improving. In the last 500 days, we must all do everything we can to reach the MDG targets. Serious and fast action is required to address the shortfalls in investment in maternal, newborn and child health. Each and every one of the 300 commitment makers, including 70 governments must deliver on their promises to the Global Strategy for Women and Children. We must now #Commit2Deliver.

The Nigerian Government specifically committed to:
1. Reduce Maternal Mortality Ratio (MMR) from what it was previously to about 250/100,000 by September 2015.
2. Commit to achieving the goal of a contraceptive prevalence rate (CPR) of 36 % by 2018. Achieving this goal will mean averting at least 31,000 maternal deaths.
3. Ensure the availability of Reproductive Health Commodities including lifesaving drugs for women and newborn in our secondary and primary health care facilities
4. Passage into law the long awaited national health care bill which will boost tremendously financial commitment and allocation to primary health and insurance scheme leading to improved universal coverage.

Mr. President permit me to mention some of my concerns looking at the fact that all the 4 commitments listed above none is achieved as of today. Based on the 2013 National Demographic Health Survey (NDHS) which was officially presented by the National Population Commission on Monday 16th June 2014 in Abuja, Nigeria. Our MMR is put at 576 maternal deaths per 100,000 live births which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000. It has even gone up rather than gone down. This is the time to reflect and begin to ask the hard questions of why and what are we doing wrong and what can be done to reverse the trend of MMR in Nigeria.

W.H.O’s 2013 published maternal death estimates also corroborated the 2013 NDHS as it reported Nigeria’s MMR as 560/100,000. In trying to understand the high unaccepted MMR, one need to also know some of the outcome indicators that affect MMR. The antenatal coverage for at least one visit was put at 60.6% and for four or more visits was put at 51.5%. These Percentages signifies that almost half of the women population were disenfranchised and it raises the question of equity and coverage in health care. The % of births attended by skilled health personnel was put at 38.1%, it is very poor and a red card for Nigeria being the largest economy in Africa.

Our contraceptive prevalence rate (CPR) is put at 15%. Nigeria on the 11th of July 2012 at a London Summit on Family Planning pledged to “in addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities, we are now committed to provide an additional US$8,350,000 annually over the next four years, making a total of US$33,400,000 over the next four years. This is an increase of 300 percent.” We also committed to achieving the goal of a contraceptive prevalence rate (CPR) of 36 percent by 2018. How realistic is that financial commitment going by unreleased of such funds in 2013?

We need to do more in Reproductive Health, because of the following reasons;
1. Nigeria is one of the 10 worst places in which to be a mother, and has the second highest number of newborn deaths worldwide.
2. One woman out of every 41 Nigerians faces a lifetime risk of death in childbirth. This is in contrast to Ethiopia, where one woman out of 67 faces such a risk.
3. Currently, only 15% of Nigerians married or in-union aged 15-49 use any modern method of contraception. These numbers are shockingly low, and in stark contrast to Ethiopia where the rate is 27%. In Bangladesh 52% of women married or in-union aged 15-49 are using modern methods of contraception.
4. The estimated number of maternal deaths for 2013 is 40,000.

There are only 500 days left to deliver on this promise. We are calling on you as our president to focus on ensuring the 4 listed promises above are realized before September 2015, the last month for the MDGs.
Central to ensuring that such commitments are tracked and budgeted for adequately is a thorough accountability mechanism which civil society is actively engaged in. All global and country-level accountability mechanisms should be effective, transparent and inclusive of all stakeholders. Through working together to achieve our goals, we will go so much further.
We look forward to your continued dedication to prioritizing women’s and children’s health, and to your focus on the specific areas as requested.

Aminu Magashi Garba is the Regional Lead for Africa Health Budget Network. Follow him @AminuMagashiG and @AHBNetwork and @HReporters and email GAmagashi@gmail.com

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Why they succeed; Lessons for Nigeria

(1st published in Daily Trust Newspaper of Tuesday 5th August 2014)

Why they succeed; Lessons for Nigeria

Ten low and middle-income countries (LMICs) were celebrated for the significant progress in their efforts to save the lives of women and children during the recently concluded 3rd W.H.O/PMNCH forum in Johannesburg, South Africa. They were reported to have invested in high-impact health interventions such as quality care at birth, immunization and family planning. They also made significant progress across multiple health-enhancing sectors, including for education, women’s political and economic participation, access to clean water and sanitation, poverty reduction and economic growth.

While we are at it in celebrating the 10 countries, it is imperative to know what they did and the strategies they implemented to significantly reduce maternal and child deaths. And above all to know why Nigeria couldn’t join the list of the 10 fact tracked countries.

Nigeria’s national average for immunization coverage in comparison between 2008 (23%) and 2013 (25.3%) has increased by just 2%. This means only 25% of targeted children were fully immunized. 2% increase in 5 years is poor considering the billions of naira expended in immunization programmes. The 2013 National Demographic Health Survey (NDHS) reported our Maternal Mortality Ratio (MMR) of 576 maternal deaths per 100,000 live births which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000. It has even gone up rather than gone down. In trying to understand the high unaccepted MMR, one need to also know some of the outcome indicators that affect MMR. The antenatal coverage for at least one visit was put at 60.6% and for four or more visits was put at 51.5%. These Percentages signifies that almost half of the women population were disenfranchised and it raises the question of equity in health care. The % of births attended by skilled health personnel was put at 38.1%, it is very poor and a red card for a country that is bless with avalanche of donor funded projects on maternal health and a country boasting of being the largest economy in Africa.

The contraceptive prevalence rate (CPR) was put at 15.1%. This is amidst our pledged to “in addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities, we are now committed to provide an additional US$8,350,000 annually over the next four years, making a total of US$33,400,000 over the next four years. This is an increase of 300 percent.” We also committed to achieving the goal of a contraceptive prevalence rate (CPR) of 36 percent by 2018. All these are unrealistic.
The above examples underpin Nigeria’s progress in a reverse order and why Nigeria weren’t celebrated.

In celebrating the 10 countries, the international community shared an overview of the Success Factors for Women’s and Children’s Health studies. It is observed that “there have been substantial achievements towards MDGs 4 and 5 (to reduce child mortality and improve maternal health) from 1990 (the baseline for the MDGs) to date. Child and maternal deaths both decreased globally by around 50%, and contraceptive prevalence increased from 55% to 63%. There is consensus on evidence-based, cost-effective investments and interventions and on enabling health and multisectoral policies.”
The Success Factors study series included statistical and econometric analyses of data from 144 LMICs over 20 years, qualitative comparative analysis (QCA) across all LMICs, a literature review and country multistakeholder policy reviews in 10 LMICs that were on the fast track, ahead of other comparable countries, in 2012 to achieving MDGs 4 and 5a (hereafter referred to as fast-track countries.

The celebrants are Bangladesh, Cambodia; China, Egypt; Ethiopia, Lao PDR, Nepal, Peru, Rwanda and Viet Nam.

What are the Shared strategies, unique approaches: Lessons learned from fast-track countries?

The Success Factors studies show us that maternal and child mortality can decline rapidly in low- and middle-income countries when different actors across society collaborate to improve women’s and children’s health. Remarkable results can be achieved when this approach is underpinned by robust data and strategies tailored to countries’ unique situations – especially if the political will and resources exist to maintain long-term focus. All the 10 fast-track countries in this report have demonstrated some or all of these qualities and strategies. In each country the mix has been different, depending on local context and priorities. However, the clear message is that coordinated multistakeholder partnerships, multisector action, guided by sound data and strategic vision, delivers results. We’ve summarized the three main elements of this approach as:

1. Multisector progress – progressing on MDGs 4 and 5 as well as most of the other MDGs (e.g. reducing poverty and hunger and improving education and gender equality).

2. Catalytic strategies – optimizing the use of resources and maximizing health outcomes through effective leadership, evidence-informed decision-making and partnerships across society.

3. Guiding principles – using widely accepted principles, legal frameworks – including for human rights and development effectiveness – and political and economic models to shape policies and focus action. In practical terms, this breaks down into a number of broad strategies that characterize fast-track success.

Fast-track countries focus first where they know they can make a difference quickly and sustainably. Often this means strengthening the capacity of the health system to provide basic RMNCH services that people in high-income countries might take for granted. Since 1990, investments in proven high-impact interventions, such as skilled care at birth, immunization and family planning, have accounted for about 50% of the reduction in child mortality.

Looking at where we are in Nigeria with respect to poor maternal and child health indices, there are a lot to learn from the 10 celebrants.

All comments to Dr Aminu Magashi at healthweekly@yahoo.com and follow me on twitter @AminuMagashiG

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Let’s chat about Ebola

(1st published in Daily Trust Newspaper of Tuesday 29th July 2014)

The news about Ebola Virus Disease (EVD) is spreading in Nigeria, some people being indifferent while some exercising fear that it may catch up with us. Another group is also concern about getting simple information about the virus to ensure better preparedness and prevention. Already WHO has confirmed an outbreak in West Africa in Sierra Leone, Liberia, and Guinea.  Between 18th – 20th July 2014, 45 new cases and 28 deaths were reported from Guinea, Liberia, and Sierra Leone. These include suspect, probable, and laboratory-confirmed cases.  Some newspaper have reported that the 1st case of Ebola is confirmed in Lagos, Nigeria. This development amplify apprehension which necessitated providing simple information about Ebola.

Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a case fatality rate of up to 90%. It is one of the world’s most virulent diseases. The infection is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people. Severely ill patients require intensive supportive care. During an outbreak, those at higher risk of infection are health workers, family members and others in close contact with sick people and deceased patients.

Ebola virus disease outbreaks can devastate families and communities, but the infection can be controlled through the use of recommended protective measures in clinics and hospitals, at community gatherings, or at home. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees). Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.

How do people become infected with the virus?

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats, monkeys or apes) including not picking up dead animals found lying in the forest or handling their raw meat.

Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human. Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Persons who have died of Ebola must be handled using strong protective clothing and gloves, and be buried immediately. People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.

Who is most at risk?

  1. During an outbreak, those at higher risk of infection are:
  2. Health workers;
  3. Family members or others in close contact with infected people;
  4. Mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and
  5. Hunters in the rain forest who come into contact with dead animals found lying in the forest.

What are typical signs and symptoms of infection?

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patient becomes contagious once they begin to show symptoms. They are not contagious during the incubation period. Ebola virus disease infections can only be confirmed through laboratory testing.

When should someone seek medical care?

If a person has been in an area known to have Ebola virus disease or in contact with a person known or suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately. Prompt medical care is essential to improving the rate of survival from the disease. It is also important to control spread of the disease and infection control procedures need to be started immediately. Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease. To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.

 Aminu Magashi Graba is the Regional Lead for Africa Health Budget Network; email to  healthweekly@yahoo.com and follow me at @AminuMagashiG and @AHBNetwork 


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The launch of the Every Newborn Action Plan

(1st published in Daily Trust Newspaper of Tuesday 22nd July 2014)

The 3rd W.H.O/PMNCH Forum that took place in Johannesburg, South Africa; Monday 30th June – Tuesday 1st July 2014 which was a gathering of ‘Who is Who’ in the health sector has witnessed the launch of the Every Newborn Action Plan. A strategic document if and when implemented by countries will see tremendous progress in saving the lives of many newborn.

To justify why the global community must invest in Every Newborn, is to make some reference to the Lancet series on Every Newborn that was released on May 19th, 2014. It observed among others that “Every day, 15,000 babies are born and die without ever receiving a piece of paper. The lack of recording reflects the world’s acceptance that these deaths are inevitable. This fatalism, lack of attention, and lack of investment are the reasons behind lagging progress in reducing newborn deaths – and even slower for progress in reducing stillbirths. In reality, these deaths are nearly all preventable,” said Professor Lawn of the London School of Hygiene & Tropical Medicine and senior health advisor to Save the Children.

And also reiterated that without greater investments to improve birth outcomes around the world, by 2035 there will be 116 million newborn deaths, 31 million surviving babies and children with disabilities, and 68 million with lost development potential because of stunting.

The Every Newborn action plan is based on the latest epidemiology, evidence and global and country learning, and supports the United Nations Secretary-General’s Every Woman Every Child movement. The preparation was guided by the advice of experts and partners, led by WHO and UNICEF, and by the outcome of several multi-stakeholder consultations and a web-based consultation with more than 300 comments. Discussed at the 67th World Health Assembly, Member States endorsed the document and made firm commitments to put in practice recommended actions. The Director General has been requested to monitor progress towards the achievement of the global goal and targets and report periodically to the Health Assembly until 2030.

While writing his ‘Foreword’ for the action plan the UN Secretary-General Ban Ki-moon observed that “It is time to give newborns a more prominent place on the global health agenda. We must do much more to save the 2.9 million newborns dying during their first 28 days of life each year. The day of birth is the most dangerous day, when nearly half of maternal and newborn deaths and stillbirths occur. It is also the day babies face the greatest risk of disability. Protecting newborns means ensuring proper care for their mothers before, during and after pregnancy.”

During the launch it was reiterated that we have unprecedented opportunities to turn the tide and address newborn health, as far more is known about effective interventions, service delivery channels and approaches to accelerate coverage and quality of care. Recently, renewed commitments to saving newborn lives and preventing stillbirths have been made by many governments and partners in response to the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health. The Every Newborn action plan is based on epidemiology, evidence, and global and country learning, setting a framework to end preventable newborn deaths and stillbirths by 2035.

The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health (RMNCAH) strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability.
Below are some useful key messages;

1. 3 million babies and women could be saved each year through investing in quality care around the time of birth and special care for sick and small newborns. Cost-effective solutions are now available to protect women and children from the most dangerous day of their lives – the day of birth.

2. Unfinished agenda: Newborn health and stillbirths are part of the “unfinished agenda” of the Millennium Development Goals for women’s and children’s health. With newborn deaths still accounting for 44% of under-5 deaths globally, newborn mortality and stillbirths require greater visibility in the emerging post-2015 sustainable development agenda if the overall under-5 mortality is to be reduced.

3. We have solutions to address the main causes of newborn death: More than 80% of all newborn deaths result from three preventable and treatable conditions – complications due to prematurity, intrapartum-related deaths (including birth asphyxia) and neonatal infections. Cost-effective, proven interventions exist to prevent and treat each main cause.

4. Women’s and children’s health is a smart investment, particularly with specific attention to care at birth: High coverage of care around the time of birth and care of small and sick newborns would save nearly 3 million lives (women, newborns and stillbirths) each year at an additional running cost of only US$ 1.15 per person in 75 high burden countries. This would have a triple impact on investments – saving women and newborns and preventing stillbirths.

The time to act for our Newborns is now and everybody must rise up to expectation.

Aminu Magashi Garba is the Regional Lead for Africa Health Budget Network. Follow him @AminuMagashiG and @AHBNetwork and email GAmagashi@gmail.com

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“No woman, no adolescent, no child left behind”

(1st published in Daily Trust Newspaper of Tuesday 15th July 14)

The title of my article today was the communique slogan for the recently concluded 3rd W.H.O/PMNCH Forum that took place in Johannesburg, South Africa; Monday 30th June – Tuesday 1st July 2014. It was arguably rated as one of the most influential political meeting on health in recent years. It was a gathering of about 1,200 participants from 60 or more countries hosted by the Government of South Africa, PMNCH, Countdown to 2015, A Promise Renewed and the independent Expert Review Group.

A commitment for the women and children was demonstrated by leaders such as Norwegian Prime Minister Erna Solberg and South Africa Deputy President Cyril Ramaphosa, PMNCH board chair Mrs Graça Machel and Archbishop Desmond Tutu. Also Ministers, Heads of Agencies – WHO’s Dr Margaret Chan, and UNFPA’s Prof. Babatunde Osotimehin – representatives of the Secretary-General, traditional leaders, civil society, private sector, many African Health Ministers and  60 youth leaders who developed their own Youth Outcome Document.

The meeting also launched the much-awaited reports: The Every Newborn Action Plan (along with 40 commitments to Every Woman Every Child), the Countdown to 2015 report and the Success Factors report. Through the Success Factors, highlight of the importance of working with sectors beyond health were featured.

At the end of the meeting a draft communiqué was presented which contain lots of useful information and call to attention expected of all of us for the sake of our women and children.

Ensuring the health and wellbeing of every woman, child, newborn and adolescent, the meeting reaffirm that the health of women, newborns, children and adolescents is a human right and at the heart of a people-centered approach to sustainable development. It also applaud the progress in almost halving global maternal and child mortality since 1990 and note in particular the achievements on women and children’s health since the 2010 launch of the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, the related Every Woman Every Child movement, and regional initiatives such as the African Union’s CARMMA and the Maputo Plan of Action. 

It however observed that progress has been uneven in many countries, with marginalized and underserved groups, including adolescents and newborns making the least progress. It also recognize the right of marginalized and underserved groups, including young people, to actively participate as partners in the design of policies and strategies that affect their lives and health. 

Also stress that universal access to sexual and reproductive health and rights, including quality, comprehensive and integrated sexual and reproductive health information, education, services and supplies, is central to ending preventable maternal, newborn, child and adolescent morbidity and mortality and preventing stillbirths. It reaffirm that country leadership, including both governments and civil society, is vital for the success of these efforts.

It also call on the following

  1. Invest in poor and marginalized populations and in other groups requiring special attention, such as newborns and adolescents. Support community-led efforts to address these challenges and advance inclusion. 
  2. Invest in high-impact health interventions, such as immunization; skilled attendance at birth and quality care for mothers and newborns; access to contraception; prevention, diagnosis and treatment of HIV, malaria and TB, as set out in the Global Investment Framework for Women’s and Children’s Health and the Commission on Investing in Health.  
  3. Invest in high-impact, health-enhancing interventions in other sectors to improve education, skills and employment; access to clean water, sanitation and hygiene; nutrition; rural electrification; roads; and women’s political and economic participation, including preventing early and forced marriage. 
  4. Couple these investments with long-term strategies that ensure sustainability through innovations and strengthening health systems to facilitate scaled-up access to quality health services.

For the post-2015 Sustainable Development Goals, targets and indicators, the meeting emphasize the need to;

  1. Include, at a minimum, a standalone health goal to uphold health as a human right and to maximize access to health and wellbeing, end preventable mortality and morbidity and meet individual demand for sexual and reproductive health and contraception and to be aware that other goals might emerge, for example on RMNCH. 
  2. Endorse global targets for 2030 to reduce child mortality to 25 or fewer deaths per 1,000 live births, newborn mortality to 12 of fewer deaths per 1,000 live births, and to reduce maternal mortality in all countries to a global ratio of less than 70 per 100,000 live births and a minimum of 75 percent of demand for contraceptives is met by modern methods. 
  3. Commit to differentiated targets and indicators to guarantee focus on key populations including adolescents, marginalized and underserved groups, and to take into account different levels of development in countries. 

It also calls on countries to do the following;

  1. Establish shared goals with health-enhancing sectors, such as education, nutrition, water and sanitation, rural electrification, roads, skills and employment.
  2. Develop capacity for multi-stakeholder and multi-sector partnerships in order to maximize health outcomes and the contribution that better health makes to other sectors. 
  3. Strengthen the capacity of civil society and ensure the meaningful engagement of young people and other key populations in policy-making and implementation, as well as in holding stakeholders to account. 
  4. Develop civil registration and vital statistics systems and strengthen national health information systems to collect and publish key RMNCH data, including for neglected groups such as newborns and adolescents. 
  5. Support good governance and leadership at all levels of government, civil society, the private sector and the global community, strengthened by the use of timely, reliable data and evidence for transparency in decision-making and accountability.

In conclusion no one should be left behind and there is no room for complacency. 

All comments to Dr Aminu Magashi at healthweekly@yahoo.com



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Poor Immunization; Are the Governors aware of that?

(Published in Daily Trust Newspaper of Tuesday 8th July 2014)

While I was in faraway Johannesburg, South Africa last week participating at the 3rd W.H.O/PMNCH forum arguably the most strategic political health advocacy meeting in recent time and of course launching the Africa Health Budget Network to demand for more transparency and accountability in Africa. I received an anonymous mail as follows “Aminu, I want to share these few words anonymously with you. Iam a senior colleague and highly placed in the development community in Nigeria. Your column seems to be the only space critically analysing health issues and calling on political leaders to take action in Nigeria. I must commend your effort, courage and resilient in writing weekly and taken on myriad health issues in Nigeria. Please for the sake of Nigerian children I want you take a look at the immunisation coverage in Nigeria in the recently released National Demographic Health Survey and see for yourself and may be write about it. Wishing you and your paper Daily Trust all the best in this onerous task of engaging policy makers.”

By all intent today I wanted to write about the Johannesburg conference with all the interesting things that happened there but after going through that mail and also reading in detail the 2013 National Demographic Health Survey (NDHS) especially the section of immunisation in Nigeria, I lost appetite and was flabbergasted as to how the health of our children has deteriorated over the last 5 years since the 2008 NDHS. I didn’t only read the 2013, I had to study the 2008 in order to do a better comparison.

My article will be about stating the figures and asking questions focusing more on the governors of the states with the appalling figures. According to the World Health Organisation, a child is considered fully vaccinated if he or she has received a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertussis, and tetanus (DPT); at least three doses of polio vaccine; and one dose of measles vaccine. These vaccinations should be received during the first year of life. In Nigeria, BCG and Polio 0 vaccine should be given at birth, DPT and polio vaccines should be given at approximately 6, 10,and 14 weeks of age. Measles vaccine should be given at or soon after the child reaches nine months of age. It is also recommended that children receive the complete schedule of vaccinations before their first birthday and that the vaccinations be recorded on a health card given to the parents or guardians.

Overall the national average in comparison between 2008 (23%) and 2013 (25.3%) has increased by only 2%. This means only 25% of targeted children were fully immunised. 2% increase in 5 years is poor considering the billions of naira expended in immunisation programmes and project by domestic and international donor funds. It is important for us to take a step back and review our interventions with a view to understand what was working and what wasn’t working well and how best we can reinvigorate efforts.

Both the 2008 and 2013 survey have shown that the biggest problem of coverage were found in Northern Nigeria. The pattern is the same for both the 2008 and 2013 surveys which have shown that the biggest problem of coverage were found in Northeast and Northwest. Northwest had 6% and 9.6% coverage in 2008 and 2013 respectively while the northeast has 7.8% and 14.2% coverage in 2008 and 2013 respectively. The worst state in Nigeria is located in Northwest which was Sokoto with 1.4% immunisation coverage in 2013. It means only 1.4 % of the targeted children for immunisation were fully covered. I hope the new current Minister of State for Health who is from the state, Governor Wammako and his commissioner of health are aware of this scandalous poor record?
The states that bordered Sokoto States did also poorly with Kebbi 2.8% and Zamfara 2.1%. Are the governors of these 2 states aware of this development? Are they briefed by their commissioners of health and informed them about the implication for the survival of children? Another state that didn’t do well in the Northwest was Jigawa States with 3.6% coverage.

Looking at Northeast: Yobe, Bauchi and Borno have performed poorly in 2013 survey with 6.9%, 6.1% and 9.7% respectively. Are the governors of these 2 states aware of this development? Are they briefed by their commissioners of health and informed them about the implication for the survival of children?
This poor data is a clarion call for the sitting governors to call for emergency health meetings and review performance and ask the hard questions of what was going wrong and what could be done to redress the issue.
Is Nigeria part of the ‘A PROMISE RENEWED’ which is a global movement to end preventable child deaths? I want to assume the answer is yes. What are the 2 Ministers of Health and the executive secretary of the National Primary Health Care Development Agency doing about this appalling immunisation coverage figure? Are they comfortable with this level of progress?

Under the banner of Committing to Child Survival: A Promise Renewed (APR) 176 governments including Nigeria signed a pledge, vowing to accelerate progress on child survival. Each pledge represents a serious political commitment to save children from dying of preventable causes. Under the stewardship of the Government of Ethiopia, more than 20 sub-saharan African leaders reaffirm their collective commitment to reduce under-five mortality rates to less than 20 deaths per 1,000 live births by 2035. Indeed the NDHS 2013 immunisation coverage is a slap on Nigeria as one of the countries that signed the APR.

All comments to Dr Aminu Magashi at healthweekly@yahoo.com and follow me on twitter @AminuMagashiG

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