PRINCIPLES OF INTERNATIONAL HEALTH: THEORIES AND PRACTICES IN NIGERIA



·        Introduction
 ·        Factors driving Nigeria contribution to medical tourism in India
·        Traditional medical practices in Nigeria
·        Nigeria cultural practices and health
·        Some harmful cultural practices in Nigeria
·        Traditional and herbal health care in Nigeria
·        Reference


Health Theory and practice in Nigeria

Introduction
International health partners is a group of partners committed to improving the health of citizens in developing countries. Partners work together to put international principles for effective aid and development, cooperation to practice in health sector. International health partnership began on 5th September 2007 with 27 developing countries, government partners, civil society, organization and non-state actors. Currently there are 59 signatories improving health. Health service is a complex task in any country, it involves government health workers, civil society, parliamentarian and other stake holders.
            In developing countries money for health comes from both domestic and external resources. This simple means that government must also work with range of international development partners. International health partnership mobilizes partners to support comprehensive country-led health strategies in a well coo-ordinate way. Many principles were adopted and put into practice in the health sector to bring about effective health delivery. The international health combined these principles and put them into practice in the health sector to encourage wide support for single national health plan, evaluation monitoring with strong emphasis on partners holding each other to account.
            These principles aims to build confidence between government, civil society, development partners and others whose activities affect health.
            The partners are increasing in number using different funding streams and have diverse bureaucratic demands.
In 2005, Paris declaration on aid effectiveness set out Principles for making aid more effective using GAVIS approach.
These principles include:
1.         Principle of ownership: GAVI provides supports to expand Access to immunization plans. This accessibility enable country to better plan and increase the value of  the support.
2.         Principle of alignment GAVI providing support for countries own priorities asset out in their national health and immunization plan.
3.         Principle of harmonization: By producing resources at the global level, GAVI also support hamonization efforts through international health partnership, support working with national health sector.
4.         Principle of mutual accountability and managing for result. GAVI brings together its partners in the alliance board which hold all parties to account for their respective responsibilities.
            In 2011, the busan high level forum on aid effectiveness came out with emphasis on considering domestic and external resources together. The international health partnership put these various principles into practice in health sectors and accelerate progress towards millennium development goals.
            IHP+ achieve results by mobilizing national government agencies, civil society and others to support a single country.-lead national health strategy or plan, a single monitoring and evaluation framework and strong emphasis on partners holding each other to account. IHP+ is about people and organization at local, national global levels uniting for a healthier future.
            The high patronage of Nigerians to procure medical treatment in India and other developed countries speaks eloquently of the decadence in the health care policy, governance contributions to global medical tourism at the experience of developing local capacity and knowledge to deliver quality and ever affordable health care to the Nigeria population?
            Nigeria healthcare policy, governance and practice could be classified as under developed rather than decadent. Nigeria health policy since 1960 has remained statistic apart from introduction of primary healthcare policy in the 1980’s and the Nigerian national health insurance policy in 2005. Implementation of both policies have been abysmally poor and so they have not made any impact.
            Nigeria’s health governance since independence remains the same. Government provides free or subsidized health care in competition with private providers who charge money for health care. There is no integrated health system that is all embracing where government and private providers work in synergy as is done in many developed and developing countries. In Nigeria, over 90% of common folk go to government hospitals for free or highly subsidized medical care. How ever, statistics show that not more than 10% of doctors practicing in Nigeria are employed by government. Free healthy care is therefore unacceptably cumbersome. Patients may line up in a government hospital from 9 am to 4 pm before they can see a doctor for diagnosis and treatment. This is because there are many Patients and very few doctors. There may be over 120 patients and only 2 or 3 doctors available to see them. In contrast, doctors working at the surrounding private hospital may be quite idle with very few Patients to see.
            In our healthcare practice, Nigeria is still in stage one healthcare development with practice characteristics of the 19th or 20th century health system.
            Stage one healthcare development is characterized by highly fragmented delivery system with physicians hospitals and other health care organizations functioning autonomously. Patients rely on physician training and experience to make best decisions. Patients roll is passive and they have no control over treatment decisions. Information technology and tools are entirely absent.
            Medical practice in many developed and developing countries is now in stage 4 healthcare development which is the health system of the 21st century. In stage 4 health care practice, health care organizations have the characteristics of high performing organization and focus on six aim for improvement; safety, effectiveness, Patients centeredness, timeliness efficiency, equity.
            Patients have as much control as they want over treatment decisions and services are coordinated across practice with generous use of information system. A lot of hard work will need to be done to move our care system to stage 4. It will require training and retraining of our medical practitioners, our nurses and other health workers, healthcare administrators or and educating the populace. According to criteria stage 4 health practice, health care should be:
*          Safe:   Avoiding injuries to patients from the care that is intended to
help them.
*          Effective:  Providing services based on scientific knowledge to all who can benefit.

Patient-centred: Providing care that is respectful of and responsive to
individual preferences, needs and value
Timely: Reducing waits and undue delays
Efficient: Avoiding waste of supplies, ideas, energy.
Equitable: Providing health services that does not vary in quality because of
personal characteristics, gender, ethnicity or socioeconomics status.
Our health system should be geared toward meeting the above criteria.

FACTORS DRIVING NIGERIA’S CONTRIBUTION TO MEDICAL TOURISM
The 1st factor is patients choice: Rightly or wrongly, going to India has become a fad among Nigerians who can afford it. Even those who cannot afford it beg for money. This is the nature of health seeking behaviour of Nigerians today. All over the world, health seeking behaviour has not always been rational or based on doctor’s advice. Booter and Bachuk in USA reported in 1972 that in United State of America, more patients tended to consult lay persons in kin and friendship network than to consult medical person when about to decide how to seek medical help and that they lay person tend to provide advice based on their specific knowledge of bias.
            In a study in Igun in Nigeria, most persons sought the type of treatment they need for their illness usually on advice of friends or neighbours. Social network therefore has a powerful influence on health seeking behaviour and that is what is partly driving the India fad. Many Nigerians believe India is place to for specialist treatment and usually advise their friends or neighbours to do so.
The second is doctor factors: Many doctors in Nigeria needs re-training to upgrade their practice from stage to the current 21st century stage 4 health system. Many doctors should be taught to know when to refer patient to other experts and where the experts are in Nigeria, some doctors refer directly to India instead of Nigerian experts, partly because they do not know them and partly because they are given generous incentives to do so by way of commissions from the Indian hospitals. On the one hand, there may be probably more Nigerian doctors practicing abroad than those working in the country, and we have issues around inadequate knowledge and skill by practicing Nigerian doctors in the country. It is true that more Nigeria doctors are practicing abroad than those working in Nigeria. If all this Nigerian were to be working in the country, many people from other countries in Africa would have been coming to Nigeria on medical tourism. Many of these Nigerian doctors abroad have world class knowledge and skills.
            The answer is obvious, practice of medicine is not rewarding in Nigeria. Most doctors employed in government services are poorly paid and as a result of this, medical Professionals would prefer displaying their talent abroad for better payment.

Equipment shortage: some has link the poor health services to equipment shortage. Though this may be a contributory factors but equipment shortage is not the problem in Nigeria. The weakest link in our medical system is availability of skilled medical experts, and then give the experts the equipment they need and pay then well.
            At present, Nigeria governments and Nigerians political elites have no respects for skilled Nigerian professionals and little interest in training highly skilled medical experts for Nigerian health system. They undervalue highly educated professions hence many of them are out side Nigeria.           
            The various government (Federal, State and Local) play a dominant role in health care provision in Nigeria. Since they promise to provide free or subsidized health care fore the ordinary Nigerians who cannot afford private clinics or hospital. These government are therefore partly to blame for the state of health care in the country.
            The near collapse of our healthcare is as a result of poor financing of the free health care. The better option is to have a health financing arrangement that takes care of every one. This can be done with a credible health insurance system where all workers are covered and self employed or unemployed persons covered by a community health insurance system where people pay premium and government subsidizes the premium of those who are poor and unemployed.
            This will make health care a viable business where both private providers and government institutions work in synergy as partners. As at now, many state governors are not interested in the national health insurance system and those who entertain the idea of community health insurance want to run it themselves the way they are running their free healthcare system. Health management organizations (HMO) drive the Nigeria health insurance system in Nigeria.
            Insurance is about pulling resources of a larger number of people together to give a cover to those of them who might be ill. By actuarial principles, the larger the number in a group the smaller the viable premium each may pay. An individual who insures for N1,500 a month may use up over N5,000 just one illness.
Continuing professional development and medical education of Nigeria health professionals to keep abreast of current development in medical practice are coupling necessities. As earlier pointed only the weakest link in provision of quality health care in Nigeria is the knowledge of practicing health professionals, and not necessarily availability of sophisticated equipments.
            Nigeria developmental finance from, Nigeria operating 19th century health system by Mustapha Danes, 2012.

Traditional medicine practice
This is yet another type of health practice in Nigeria apart from the orthodox medical practice. Nigeria is formulating a new health policy to integrate traditional medicine practice into orthodox medicine practice as a part of the strategies to scale up health care delivery in the country. Government is working with the traditional medicine practitioners to standardize the traditional medicine practice in the country. Government saw the need to train this group on anatomy, physiology, pathology and therapeutics for them to fit in into achieving effect health care system.

Nigerian Cultural Practices and Health
The cultural practices of a people not only affected their health but also affect all their affairs including health and disease. Man living in an interactive society is affected by what happens in his environment and how he reacts to it. i.e, the deterrent and determinants of health and disease in a community cannot be completed unless the cultural practices of the people are considered. Many cultural practices have helped to perpetuate health problems in Nigeria. However, not all cultural practices and beliefs in Nigeria are bad. Many have and withstood centuries and actually promote health. But there are some cultural practices which encourage disease prevalence and propagation. Most of these negative practices are due to ignorance and non-availability of better alternatives. Efforts should be made to encourage those practices that promote health through provision of information and better health care services.

Some of the Nigeria health practice which promote health includes:
-           The common practice for mothers to breasted their children for a long time. It is a good practice because breast milk is better then any other food a child can receive within the first 6 months to one year.
-           Also the common practice in Igbo and eastern Nigeria for women who have just delivered to be placed on special diet. This they believe helps the woman to regain lost nutrient during pregnancy which is fact.
            Sexual abstinence during lactation is also widely practice among the Igbos because of the belief that a women is not fully pure at this time. This practice helps in child spacing and family planning.
            Also among the Ibos, the Binis, the Ijawse and several other ethnic groups in the southern Nigeria, it is a common practice for people to Embark on wrestling combat when it is not farming season. This promote physical activities and health.

Environmental Sanitation: This is practiced virtually in every Nigeria society. Early morning sweeping of the house and compound by both men and women is encouraged.

Some harmful cultural practices in Nigeria
            In the western part of the country, it is common practice to use cow dung to clean umbilical cord. This is a dangerous practice which infect the neonate cord and result to neonatal tetanus.
Also in typical Nigeria rural society children are usually not given food like egg for fear of becoming a thief. This deprive children the essential food they need and may lead to malnutrition disorder.
Female and male circumcision is practiced not only in Nigeria but also in about 26 countries of Africa.  
Scarification and tribal marks are practiced commonly all over Nigeria especially in the southwest and northern Nigeria. This how ever expose them to infections like tetanus etc if not done in clean environment.   


Traditional and herbal health care in Nigeria: Contribution by Ndubusis S. Debe January 24/2011

Traditional medicine also known as indigenous medicine and comprises of medical knowledge system that developed over generations within various society before the era of modern medicine.
This practices include: herbal, traditional Chinese medicine Islamic medicine, acupuncture, Traditional African medicine etc.

WHO define traditional medicine as: “the health practices, approaches, knowledge and beliefs incorporating plant, animal, mineral based medicines, spiritual theories, Manuel techniques and exercise, applied singularly or in combination to treat, diagnose and prevent illness or maintain well-being.
            In some Asia and Africa countries, up to 80% of the population beliefs on traditional medicine or practice for their primary health care needs. When adopted outside of its traditional culture, traditional machine is often called complimentary alternatives medicine.
            Nigerian people and even the government have equally got the awareness of the role and need for alternative means of health care for the people.

REFERENCES

Aid effectiveness: GAVI applies the principles and as set out in pari declaration on AID effectiveness and the Accra for action – Google.

Britain launches global health care plan for poor countries ABC News (Australis) September 6 2007.

Brown launches global health plan: Associated press in the Hindy, September 5, 2007.

Bobby Ramatant, September 11th 2007. Asian Tribune International Health partnership to strengthen health system.

McCoy, David (2011) The HP+: A welcome initiative with an uncertain feature. Global Health and development guiding principles.S

Ndubisi S. Dube, 2011. Traditional and herbal health care in Nigeria.
Mustapha Danes, 2012 Nigeria operation 19th century health system 

Onyeabochukwu Duke Augustine. Cultural practices and health: The Nigeria experience. Department of median and surgery university of Nigeria Enugu Campus.

Principles of international health-Google.
International health partnership.
- IHP+ The international health partnership
-           Global Health and development-about the Alliance-GAVI Alliance
-           Global health and development guiding principles.
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