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The future of healthcare (2)



health teaching<br />hospital

Continued from yesterday
Ebola and other communicable diseases
THE recent Ebola outbreak in West Africa has awakened the world to its unpreparedness to fight new types of communicable diseases. Governments across the world and West Africa in particular are now fully aware of the need for public health vigilance for new and dangerous communicable diseases such as Ebola. Its economic consequences will be felt for quite some time in the worst affected West African states. Countries, therefore, need a very robust public health service that is prepared to fight such disease outbreak at any time.

The robust public health service must take into consideration, adequate sanitation and availability of clean water for all its citizens. Health education must now be a compulsory part of civic education from an early age for all children.

Other types of communicable diseases we must continue to be aware of include Malaria, HIV, Tuberculosis and Polio. The Minister of Health must now be prepared to work regularly with the various Commissioners of Health in all the states. The same will apply to Public Health doctors at both federal and state levels. Data collection and analysis by a Health Care Forum (consisting of the Minister of Health and Commissioners of Health) will help monitor public health on a more regular basis than has been done before now.

The Federal Ministry of Health will work with the WHO and WISH and other health NGOs to see a fully developed public health service. There will then be no reason why we cannot eradicate polio within a few months.

The need to develop an action plan for Anti-microbial Resistance (AMR) was also discussed at the summit. The section chaired by Dame Sally Davies the Chief Medical Officer for England and Wales agreed on the urgency of dealing with this problem. In particular, there is a lot of drug resistance to Malaria, TB and some other bacterial infections. Despite initiatives to combat AMR over many years, there is little indication that the situation is improving. However, the WHO Global Action Plan (GAP) to be agreed in May 2015 aims to change this by making member states and others accountable for action on AMR.

The issue of communicable diseases is no longer just a third world problem. With increasing global travel, the spread of infectious diseases has never been easier and Ebola outbreak has made the world to stop and think of the mechanisms we have in place to prevent global health crisis.

The areas to be focused on, from lessons of EBOLA include:
• How should the global health community prioritise its response to the threat of infectious diseases?
• We have to develop new surveillance tools to monitor and detect outbreaks.
• We have to agree on mechanisms that can be used to set up rapid response teams.
• The role of vaccines will need to be reviewed including how to speed up trials and make vaccines available to poorer countries.

Maternal and newborn health
The need to put mothers and newborns first was also critically discussed. Reproductive health issues are the leading cause of death and disability for girls and women between the ages of 15 and 44 globally. In 2013, more than 280,000 women and girls died unnecessarily due to complications of pregnancy and child birth. At a global level, the level of maternal mortality is decreasing; however, maternal mortality rate is not decreasing enough in low and middle income countries where maternal deaths are all too common. Worldwide, more than 2.9 million newborns died in 2013 comprising roughly 44 per cent of all deaths of children younger than five years of age. Up to half a million babies in Africa die on the day they are born. The majority of newborn deaths are caused by infections, complications of premature birth and birth asphyxia (difficulty with breathing).

The Global Investment Framework for women and children’s health has estimated that with the modest investment of $5 per person annually, the deaths of 50 million newborns and five million pregnancy-related fatalities can be averted in the next 20 years.

The United Nations Millennium Development Goals (MDGs) form a blue print agreed by all countries in the world and all the leading development institutions to meet the needs of the world’s poorest by 2015. Three of the eight MDGs focus on challenges that directly affect women and children – decreasing preventable maternal, newborn and child mortality (goals 4 and 5) and reducing HIV and AIDS , Malaria and other conditions that significantly affect women and children (goal 6).
While there have been many achievements linked to the MDGs since 2000, there remain enduring challenges that must be acknowledged and solved with new and innovative strategies. A new Sustainable Development Goals (SDGs) will follow critical crossroads (the transition from MDGs to SDGs); it is vital that maternal newborn and child health remain at the forefront of global national health policies programming and advocacy.

There is a case for integrating policies, programs and services in ways that improve the quality and accessibility of care for mothers and newborns. For example, integration may take the form of offering newborn care, counselling during maternal visits or making contraceptive services available post-natal.

Other areas of healthcare service

Several other areas of health service delivery were also covered with policy documents produced for national health policy makers to adopt for their local conditions. These include policies on Diabetes, Mental Health and Wellbeing in children, Dementia, Patient Safety, Communicating Complex Health messages to patients and politicians, the Delivery of Affordable Cancer Care and Healthcare and Ethics. The latter reviewed the subject of GENOMICS. The Human Genome Project (HGP), a programme that has coded all the genes in humans and related initiatives has introduced powerful new methods to study the genes. Genomics has laid the foundations for new approaches to the diagnosis and treatment of human diseases as well as introducing new possibilities for reproductive choices. It continues to make a significant impact on healthcare – research in this field could one day potentially prevent thousands of illnesses. It is not surprising that the US National Genome Institute compared the HGP to the Apollo programme which saw man landing on the moon.

Human Genomics brings with it ethical, legal and social implications and in recognition of the importance of these issues, there have been unceasing number of research projects focused on this area – the era of gen-ethics is already with us.

I will strongly suggest that the Federal Government in collaboration with the private sector sets up a Nigeria Genome Project (NGP). A few of the Middle Eastern countries like Qatar and Saudi Arabia set theirs up in 2013, while the Centre for Arabic Genomic Studies was set up as far back as 2003. We must not be left behind in this key healthcare innovation.

• Concluded.
• Izegbu is professor of urological surgery.

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