HEALTH CARE DELIVERY AND HEALTH CARE DELIVERY AND RESEARCH IN NIGERIA: PERSISTENT RESEARCH IN NIGERIA: PERSISTENT

CHALLENGES CHALLENGES

BYBYTOLU ODUGBEMITOLU ODUGBEMI, , MD, Ph.D, FRCPath, PNMC, FAS, NNOM, OON.MD, Ph.D, FRCPath, PNMC, FAS, NNOM, OON.

Professor of Medical Microbiology & Parasitology,Professor of Medical Microbiology & Parasitology,Vice-Chancellor,Vice-Chancellor,

University of Lagos,University of Lagos,LAGOS, NIGERIA.LAGOS, NIGERIA.

Fifth Kola Olafimihan Endowed Lecture, College of Health Sciences, Fifth Kola Olafimihan Endowed Lecture, College of Health Sciences, University of Ilorin, Nigeria on:University of Ilorin, Nigeria on:

Thursday, December 11, 2008 at the New University Auditorium, Thursday, December 11, 2008 at the New University Auditorium, Permanent Site, Ilorin, Kwara State Permanent Site, Ilorin, Kwara State

Health care service delivery to be efficient and effective depends on commitment and sincerity of man working with appropriate tools in a conducive environment or setting.

The number of training health institutions has increased considerably over the years. The curricula of training of health professionals

vary from one institution to another.

How effective?How effective?

Medical Training In NigeriaMedical Training In Nigeria

Teaching HospitalsTeaching Hospitals Specialists HospitalsSpecialists Hospitals General HospitalsGeneral Hospitals Regulatory and Examining bodies:Regulatory and Examining bodies: National Postgraduate Medical National Postgraduate Medical

College{NPMCN}College{NPMCN} West African Postgraduate Medical West African Postgraduate Medical

College{WAPMC)College{WAPMC)

Health research and development should be based on Health research and development should be based on diagnoses of common diseases:diagnoses of common diseases: Those that account for high rates of morbidity and Those that account for high rates of morbidity and

mortality in the community with mortality in the community with Those with serious economic burden inflicted on the Those with serious economic burden inflicted on the

society. society. For compiling research data, there should be For compiling research data, there should be

well equipped and professionally trained staff in the health-well equipped and professionally trained staff in the health-care facilities, care facilities,

laboratories and research instituteslaboratories and research institutes

THE NATIONAL HEALTH POLICY AND THE NATIONAL HEALTH POLICY AND STRATEGYSTRATEGY

The three tiers of health-care system were clearly The three tiers of health-care system were clearly spelt out as:spelt out as:

Primary Health Care at Local Government Primary Health Care at Local Government LevelLevel

Secondary Health Care at State Level.Secondary Health Care at State Level. Tertiary Health Care at National Level.Tertiary Health Care at National Level.

Note that teaching hospitals are special tertiary health centres, which Note that teaching hospitals are special tertiary health centres, which serve primarily as practical grounds for training health serve primarily as practical grounds for training health professionals in the College of Medicine.professionals in the College of Medicine.

HEALTH AND RESEARCH

There is a need to undertake research at each level of our healthcare using appropriate

technology.

TABLE 3: COMMON CAUSES OF VISITS TO HEALTH CARE FACILITIES (%)

Infective and Parasitic diseases 38.2%

Respiratory diseases 12.7%

Diseases of nervous system and organ 9.9%

Ill-defined conditions 9.2%

Skin disease 8.4%

Digestive system 4.7%

Accidents 3.1%

Muscles and skeletal diseases 2.9%

Genitourinary diseases 2.7%

Blood diseases – anaemia etc 2.5%

Nutritional and metabolic diseases 1.8%

Others 3.9%

 

Focal Areas of ResearchFocal Areas of Research

Basic or BiomedicalBasic or Biomedical ClinicalClinical OperationalOperational Pharmaceutical-Drug trialsPharmaceutical-Drug trials Immunological-Serological surveysImmunological-Serological surveys Laboratory –basedLaboratory –based Field studiesField studies AppliedApplied

Basic Aspects of ResearchBasic Aspects of Research

Title: Identification of The Health ProblemTitle: Identification of The Health Problem Introduction and Literature ReviewIntroduction and Literature Review Aims and ObjectivesAims and Objectives Materials and MethodsMaterials and Methods ResultsResults DiscussionDiscussion ReferencesReferences AcknowledgementsAcknowledgements

Role of ResearchRole of Research

Important and vitalImportant and vital Adds to knowledgeAdds to knowledge Confirms old ideasConfirms old ideas Corrects old viewsCorrects old views Modifies accepted viewsModifies accepted views Creates new concepts/hypotheses/theory Creates new concepts/hypotheses/theory

POLICY OBJECTIVESPOLICY OBJECTIVES

To promote research in basic, clinical, public To promote research in basic, clinical, public health sciences at primary, secondary and health sciences at primary, secondary and tertiary health care levels in order to enhance tertiary health care levels in order to enhance quality of health amongst all Nigeriansquality of health amongst all Nigerians

Research InstitutesResearch Institutes

Medical Research Institutes should be more Medical Research Institutes should be more effective. Medical Research Institutes in effective. Medical Research Institutes in America and Europe serve as role models for America and Europe serve as role models for other research centres. For example, the other research centres. For example, the Centers for Disease Control and Prevention, at Centers for Disease Control and Prevention, at Atlanta Georgia, USA is in the forefront for Atlanta Georgia, USA is in the forefront for health research, development and Diseases health research, development and Diseases Control and preventionControl and prevention

Reference laboratories should be established at Reference laboratories should be established at each geographical zone of Nigeria.each geographical zone of Nigeria.

Health institutions should be well-equipped Health institutions should be well-equipped and properly staffed. and properly staffed.

Active collaborative research works should be Active collaborative research works should be encouraged among the various institutions at encouraged among the various institutions at local, national and international levelslocal, national and international levels

Research InstitutesResearch Institutes continuedcontinued

TrainingTrainingEffective and good training of our students at postgraduate Effective and good training of our students at postgraduate

and undergraduate levels with up-dated curriculaand undergraduate levels with up-dated curricula

Community-Based Education and Service Community-Based Education and Service (COBES) programme (Ilorin Model)(COBES) programme (Ilorin Model)

Re-trainingRe-trainingTrainers need to be retrained to prevent a ‘blind leading the Trainers need to be retrained to prevent a ‘blind leading the

blind’ situation. The introduction of Continuing blind’ situation. The introduction of Continuing Professional Education by some bodies is a most welcome-Professional Education by some bodies is a most welcome-practicepractice

FundingFundingThere should be adequate funding of our various diagnosticThere should be adequate funding of our various diagnostic

centrescentres

EthicsEthicsEthical practices should be enforced at all levels of Ethical practices should be enforced at all levels of

our health-care diagnoses and researchour health-care diagnoses and research

InformationInformationThere should be adequate and proper means of There should be adequate and proper means of

dissemination of scientific findings through peer-dissemination of scientific findings through peer-reviewed journals, bulletins and presentations at reviewed journals, bulletins and presentations at scientific conferencesscientific conferences

Monitoring, Standardization, Evaluation Monitoring, Standardization, Evaluation and Implementationand ImplementationPersonnel, equipment, supplies and laboratory Personnel, equipment, supplies and laboratory

infrastructures need to be regularly monitored to infrastructures need to be regularly monitored to ensure quality control and quality assurance which ensure quality control and quality assurance which should be adequately backed by internal and should be adequately backed by internal and external assessmentsexternal assessments

Policy and GuidelinesPolicy and GuidelinesTo ensure good research development, each To ensure good research development, each

laboratory must have guidelines and policies on all laboratory must have guidelines and policies on all procedures, practices and safetyprocedures, practices and safety

Akinkugbe, 1998 - “Through the present decade, Primary Health Care has been dramatized in a

way as never before to the detriment of the other tiers of care. It is as if you have to pull the others

down in order for PHC to thrive. Yet the successful prosecution of PHC not only depends on secondary (SHC) and Tertiary (THC), but on a

vast and varied array of social infrastructure concomitants: Food, Shelter, the Environment, Education, Roads, Water, Communication and

the Alleviation of Poverty”.

CONCLUSIONCONCLUSION

Break the jinx! – individual Nigerians are nice Break the jinx! – individual Nigerians are nice but collectively in this nation, Nigeria remains but collectively in this nation, Nigeria remains “a developing country”“a developing country”

There should be teamwork, commitment and There should be teamwork, commitment and sincere service to our nation in any one of our sincere service to our nation in any one of our callingscallings