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Cablegate: Nigeria: Weak Health System Hurting Mdgs

VZCZCXRO4599
PP RUEHMA RUEHPA
DE RUEHUJA #2274/01 3241123
ZNR UUUUU ZZH
P 191123Z NOV 08
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 4490
INFO RUEHOS/AMCONSUL LAGOS PRIORITY 0287
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 03 ABUJA 002274

SENSITIVE
SIPDIS

DEPARTMENT FOR OES/IHA WILUSZ
USAID FOR GH GREENE, HARBISON, BARTLETT AND AFR/SD HARVEY, AFR/WA
WAY
CDC FOR NCIRD/GID/DEEB ERBER

E.O. 12958: N/A
TAGS: TBIO KISL PGOV SOCI ECON KOCI EAID NI
SUBJECT: NIGERIA: WEAK HEALTH SYSTEM HURTING MDGS

SENSITIVE BUT UNCLASSIFIED - DO NOT DISTRIBUTE OUTSIDE USG.

1. (SBU) SUMMARY. On October 9, the acting Supervising Minister of
Health Mohammad Lawal, who is also the Minister of Labor, held a
press conference in which he reported on the current health status
of the nation. The report, while unrealistically laudatory of the
ministry's efforts, described a weak health system. The health
system is overburdened, under-funded and understaffed to fight the
major health challenges the country faces, while attempting to meet
the population's healthcare needs. President Yar'Adua's quest to
attain the UN's Millennium Development Goals (MDGs) of lowering
under five child mortality rate by two thirds and maternal mortality
by three fourths by 2015, is unlikely to be met without reforms in
the weak public health sector, and addressing other socio-economic
challenges that directly or indirectly influence the health of the
nation. Ambassador had the opportunity to travel with Lawal on
November 13 and underscored the need for the GON to do more to
address concerns over the resurgence of polio in Nigeria,
particularly the north. END SUMMARY.

.
RUDDERLESS MINISTRY
-------------------
.
2. (SBU) A leadership gap in the Ministry of Health has stretched
over six months since the former minister resigned due to corruption
allegations in March 2008. While the President released a list of
twenty axed ministers on October 29 and forwarded to the Senate on
November 17 (announced publicly on November 18) a partial list of
new ministerial appointments, he has not yet designated who will be
carrying which particular portfolios, including that of the health
ministry. A ten-page document distributed at the press conference
outlined the major public health threats as malaria, HIV/AIDS, and
high levels of infant, child and maternal mortality. It also
mentions assistance the GON has received from principal development
partners and enumerates self-identified accomplishments to date.
The timing of the press conference was auspicious for what was in
effect a valedictory effort by Acting Supervising Minister of Health
Mohammad Lawal. (COMMENT: The FMOH's press release at the event
largely provided old and outdated data, lacked any real reference to
malnutrition as an underlying cause of child morbidity and mortality
and is devoid of any significant discussion on reproductive health,
beyond a plan for increasing the number of midwives. Consequently,
it is difficult to objectively assess and verify challenges and
successes. END COMMENT)

3. (SBU) According to the FMOH, malaria accounts for 60% of
outpatient visits, 30% of childhood deaths, and 11% of maternal
deaths. Nigeria also suffers from a very low tuberculosis detection
rate of 30% (compared to the global rate of 70%) and has a high
tuberculosis burden with an estimated 380,000 new cases per annum.
Although the HIV prevalence rate has improved from 5.2% in 2003 to
4.4% according to the latest GON survey conducted in 2005, a lot
needs to be done to maintain the declining rate and to care for
those living with the virus. (COMMENT: A 2007 UNAIDS survey shows
a 3.1% prevalence rate, a figure used by the U.S. President's
Emergency Plan for AIDS Relief (PEPFAR). Malaria and tuberculosis
are major public health challenges, which according to observers are
not being effectively addressed by the FMOH and its state government
counterparts. END COMMENT)

4. (U) There are 210 anti-retroviral (ART) sites, 263 preventing
mother to child transmission (PMTCT) sites, and 813 HIV/AIDS
counseling and testing (HCT) sites nationwide, according to the MOH.
Currently, there are 226,000 people on ART, out of 250,000 targeted
by the GON. (NOTE: PEPFAR data shows 263 ART sites, 472 PMTCT
sites, and 731 HCT sites and nearly 199,758 individuals on PEPFAR
provided ART treatment. The disparity stems from the GON's slowness
to update data. END NOTE). Though not highlighted in the press
release, GON resources have remained to date a small fraction of the
resources for HIV service delivery efforts. The vast majority of
testing and ART treatment is in fact supported by PEPFAR, and to a
lesser extent, the Global Fund program.

5. (U) The GON is also underperforming in curtailing morbidity,
especially in children under five, from largely communicable
illnesses, such as acute respiratory diseases, measles, diarrhoeal
diseases, polio and other vaccine-preventable illnesses. The GON
has had success in almost completely eradicating guinea worm with
only 42 cases in 2007 as opposed to 653,620 in 1988. The MOH
expects the disease to be eliminated by the end of 2008. Reduction
of child and maternal mortality remains a key challenge, and per the
ministry's press release, there has been slow progress in reducing
maternal, newborn, and child mortality due to "poor access to

ABUJA 00002274 002 OF 003


medical interventions." The Ministry has adopted an integrated,
maternal, newborn and child health (IMNCH) strategy, a care system
that goes from preconception through pregnancy, child birth, and
infancy to early childhood, however the strategy has not yet taken
effect. In addition, the Ministry plans to introduce a one-year
mandatory national service for midwives.

6. (U) Health experts report the lack of safe and affordable
medicine and the proliferation of fake and counterfeit drugs
compound health problems. Nigeria lacks an efficient drug
procurement and distribution system, which has lead to the
flourishing of illegal markets for fake and counterfeit drugs.
Little is being done to ensure the safety of food, water and
chemicals used in everyday life, especially in the rural areas.
Iodine utilization has grown to 98%, a silver lining in an otherwise
dim picture. However, challenges remain including the smuggling of
non-iodized salt and re-bugging of industrial salt as table salt.


.
IMPROVING STANDARDS FOR HEALTH CARE
-----------------------------------
.
7. (U) The FMOH is putting together a new national strategic health
development plan (NSHDP), which is expected to guide the development
of the health sector. Between 2001 and 2008, the MOH has
constructed 570 model primary health centers (MPHC) nationwide and
equipped them with medical equipment, stock of essential drugs, and
forms for the collection of health statistics. The long term plan
is to have at least one functional MPHC center per political ward
nationwide.

8. (U) The Ministry has also provided training and funding to MPHC
health care practitioners for the implementation of a community
based health plan. It has also developed and is implementing a ward
minimum health care package (WMHCP) to standardize medical care
nationwide. The ministry is also working on developing and
implementing a manual on the minimum standards for PHC in Nigeria.
(COMMENT: The operational and budgetary aspects of this plan and
the responsibilities between the federal and state levels of
government have yet to be worked out, and a new child survival and
maternal child health initiative (expected in 2008) has yet to take
effect. END COMMENT).
.
INTRODUCTION OF A NATIONAL HEALTH INSURANCE SCHEME
--------------------------------------------- -----
.
9. (SBU) The MOH has a plan to expand access to the three-year old
national health insurance scheme (NHIS) beyond federal employees and
members of the armed forces, which currently covers around 2.5
million people. The plan is to expand coverage to the organized
private sector, rural communities, the urban self-employed,
vulnerable groups such as pregnant women and children under five,
and prisoners. Although the vision of providing universal access to
healthcare is laudable, whether the NHIS has the technical,
logistical, financial, and management wherewithal to efficiently run
such a wide and complicated system remains to be seen.
.
BIOMEDICAL AND PHARMACEUTICAL RESEARCH
--------------------------------------
.
10. (U) The Nigeria Institute of Medical Research (NIMR) conducts
biomedical research in the country and helps build human and
laboratory capacity in the health sector. It also collaborates with
medical schools and health institutions within and outside the
country. The National Institute for Pharmaceutical Research and
Development (NIPRD) conducts basic and translational research for
the development of pharmaceutical products. The U.S. National
Institute of Health (NIH) has a working relationship with this
institute and has funded the construction of a new chemistry and
microbiology lab completed in 2007. This lab is being used by U.S.
and Nigerian researchers for developing potential anti-tuberculosis
and other agents.
.
COMMENT
-------
.
11. (SBU) Nigeria faces serious health threats and suffers from a
weak health infrastructure that is overburdened, under-funded and
understaffed to fight major diseases while attempting to meet the
regular healthcare needs of its people. Access to basic health care
needs to be expanded, especially in the rural areas. The lack of
current and accurate public health data points to a weak health
information system, a necessary ingredient for crafting and

ABUJA 00002274 003 OF 003


implementing appropriate health interventions and policy measures.
USG assistance through PEPFAR, the President's Malaria Initiative
and USAID and CDC program funding are making significant
contributions to contain and curb the ravages of HIV/AIDS, malaria,
and polio. Nigeria needs to show much more political and financial
commitment to address the epidemiological and systemic challenges
that it faces.

12. (SBU) The FMOH's press release largely provided old and outdated
data, lacked any real reference to malnutrition as an underlying
cause of child morbidity and mortality and is devoid of any
significant discussion on reproductive health, beyond a plan for
increasing the number of midwives. Consequently it is difficult to
objectively assess and verify challenges and successes. The U.S.
Mission will continue to engage and nudge the GON so that it fulfils
its stated objective of improving the health of its people and
achieve its developmental aspirations.

13. (U) This cable was coordinated with Consulate Lagos.

SANDERS

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