Author: Idy

Healthcare Personnel Shortage and Solutions

The availability of healthcare personnel is absolutely necessary to effective and timely delivery of healthcare services to those in need. However, several healthcare institutions in Nigeria are still severely understaffed, resulting in long waiting time and further deterioration of the patient’s clinical status prior to intervention.

Addressing Personnel shortage

  • Personnel shortages are most evident in remote and rural areas
  • We need to device an incentive based system such as paying additional allowances to encourage retention of local healthcare providers, particularly doctors who tend to migrate to cities to work
  • Promote education and training of members of a target community to allow them to become associate members of the healthcare team and work within their level of training (can measure vital signs, mobilize patients, and other technical work) to alleviate the work burden on available nurses.
  • Continue to promote education for would-be healthcare providers in the field of Medicine, Nursing, Nutrition, Therapy, etc.

Clinical Franchising for Nurses can help alleviate shortage of healthcare providers in remote areas

  • Clinical franchising involves nurses having the opportunity to provide basic care and meet the healthcare demands of members of the community who do not require hospitalization, and may live far from the hospital.
  • They can provide disease monitoring for patients with chronic diseases such as hypertension and diabetes, who may be on maintenance medications, but do not have the supplies to monitor themselves and their responses to medications
  • They can also help provide rehabilitation of patients post-discharge, as there are no formal rehabilitation centers or  rehabilitation services for patients in the community. Many patients who have had significant and prolonged illnesses or stroke may be severely debilitated, but with rehabilitation, they may be able to regain some function and be capable of performing their activities of daily living even though some deficits may linger.
  • Clinical franchising requires transparency between the franchising nurse and the local hospital or clinic to allow for a seamless referral when necessary. The hospital must be supportive and understand that this helps to meet the healthcare needs of the community.
  • It can be developed further and become a form of advanced  certification for nurses and midwives, with a corresponding certificate upon completion of training.

Clinical Franchising can serve as a benchmark for the development of a formal community nursing service in Nigeria, and should involve the following process:

  • Identify the right personnel (needs nursing experience)
  • Register and train them, provide certification post training
  • Assign them to follow-up on patients living in their communities who require extra care
  • Provide supplies such as blood glucose/pressure monitoring devices etc.
  • Device a means of compensation for work done in the community
  • Each nurse should have a doctor to report complex cases to, and refer when necessary
  • Establish a referral and transfer system for patients that need to be hospitalized

The diagram below demonstrates the many roles that can be played by nurses in the community.

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Written by Dr. Idongesit udoh
Reference
Krubiner, C. B., Salmon, M., Synowiec, C., & Lagomarsino, G. (2015). Investing in nursing and enterprise: empowering women and strengthening health systems in low- and middle-income countries. Nursing Outlook, 1-7. DOI: http://dx.doi.org/10.1016/j.outlook.2015.10.007.
Nganga, N., & Byrne, M. W. (2015). Professional practice models for nurses in low-income countries: an integrative review. BMC Nursing, 14(44). DOI: 10.1186/s12912-0095-5.

Healthcare Funding in Nigeria

The Federal Ministry of Health created a policy in 2006, with the purpose of improving access, equity, and effectiveness of healthcare delivery to Nigerian citizens. With this vision, there was a mandate for the government to contribute 15% of the budget to healthcare in accordance with the 2000 declaration to expand healthcare coverage to most citizens (Uzochukwu et al., 2015). Federal, state, local governments, as well as healthcare officials must collaborate and continue to work towards the actualization of this goal. This will increase access to screening and preventative care, antenatal, intrapartum, and postpartum management, as well as disease management and monitoring for those with chronic conditions. It remains unclear what percentage of healthcare cost will be subsidized, but any form of subsidized healthcare will make a significant impact in improving healthcare access and outcomes in Nigeria.

For now, the focus of healthcare funding by federal, state, and local healthcare officials should be on providing basic healthcare to the most vulnerable population:

  • Free and timely immunization for children
  • Free prenatal care
  • Public health initiatives to educate the population about screening and management of certain disease processes, and promote the well-being of the population at large
  • Leaders of healthcare institutions (hospital or clinic) must ensure availability of basic supplies such as gloves, needles/syringes, power etc.
  • There is need for increased oversight to ensure that healthcare institutions maintain accountability to patient safety by providing basic supplies.
  • Nigerian government must look to create a form of insurance to subsidize the cost of care for patients with extensive medical needs such as those with renal failure who require renal replacement therapy like dialysis or transplant
  • Increased healthcare funding is necessary to build infrastructure and improve standards in the nation’s hospitals. This will improve the quality of care provided to patients, and curb medical tourism to foreign nations.
 Written by Dr. Idongesit Udoh
Reference
Uzochukwu, Ughasoro, Etiaba, E., Okwuosa, C., Envuladu, E., & Onwujekwe, O. E. (2015). Health care financing in Nigeria: implications for achieving universal health coverage. Nigerian Journal of Clinical Practice, 18(4), 437-444.

Addressing the Challenges (Tertiary Level Education)

University education is the goal for most of Nigeria’s youth. It is the level of education necessary for professional preparation and employment, and students strive very hard to attain this standard. However, a good percentage of Nigerian students become victims of failures in the system, which includes poor preparation and poor administration of university admission exams conducted by the Joint Admissions and Matriculation Board (JAMB), limited university seats with only 1 in 3 students receiving admission, poor funding and maintenance of academic infrastructures, and lack of opportunities for research and innovation.

Most universities require a cut-off JAMB result of 180-200 out of 400, with universities and programs in high demand requiring higher scores to qualify for admission. Many students fall short of this target, and are often relegated to multiple exam attempts, remedial programs, or courses that they do not have interest in studying, just for an opportunity to obtain a university education. In addition, many qualified applicants do not receive admission to universities because of admission malpractice, which strongly influences admission opportunities.

Attempts to expand access to tertiary education through creation of new institutions or expansion of older institutions has depleted instructional quality because funding and training of educational staff has not correlated with the demand. Institutional halls are overcrowded with high student to professor ratios that make interactive learning difficult to implement. Approximately 40% of university positions and 60% of polytechnic positions are vacant, creating a significant vacuum in higher institutions, and limiting the effectiveness of available professors.

The lack of admission opportunities and the overall poor quality of higher education in public universities in Nigeria has increased the percentage of Nigerians attending private universities within the country, and more so those who travel to other African countries like Ghana, Kenya, and South Africa, as well as the UK, USA, Canada, and Malaysia to obtain tertiary education. The focus on attaining international education has overshadowed the prioritization of maintenance and improvement of Nigeria’s academic institutions, and we have forgotten that if the decay is not arrested, it will continue to get worst.

Universities provide the highest level of education from undergraduate to post-graduate studies, and several factors need to be addressed to ensure that students are provided with quality education that prepares them for their chosen professions, and inspires their understanding of civic responsibilities and role in developing the society. Listed below are key targets necessary for improvement in the administration and quality of tertiary institutions in Nigeria:

  1. Rehabilitate existing structures, and build new ones to accommodate the growing demand for university education. For public universities, this responsibility primarily falls on the federal government and university administrators. In addition, each university should set up an alumni foundation to appeal to past alumni and other philanthropist for donations to support ongoing projects and development of the institution. Such foundations must maintain transparency and accountability to its donors by updating, and showcasing the projects that have been funded. This is necessary for continued support, as donors who do not see result will cease to donate.
  2. Recruit professors and supporting staff, and provide opportunities for continuing education to help them stay abreast of current research and findings in their subject areas. Professors are expected to attain a level of education that qualifies them as experts in their chosen fields. Therefore, administrators have a responsibility to promote and sponsor continued education and attainment of doctorate degrees by their professors. Continued education and certifications will help professors stay sharp and updated, and this will be reflected in the quality of education provided to students. Recruitment should also extend to various professionals in different fields who might have interest in sharing their knowledge, but are not necessarily desiring permanent positions. This group can be classified as guest lecturers who are scheduled to come in and share their knowledge and expertise with the students without significant compensation. There are many professionals in healthcare, science, arts, and business, who can inspire students through their service as guest lecturers. Guest lecturers provide a bridge between the classroom and the professional world and make a significant difference in the overall experience of students.
  3. Professors and university staff MUST BE PAID for their work. University students are paying tuition annually, as there are no free universities in Nigeria. Therefore, it is very sickening to see the amount of time they loose from strikes because professors are not paid. Lack of payment promotes corruption in the fabric of the school of system, as these professors begin to device means to compensate themselves for their work. Some have manufactured ‘handouts’ for sale to students, some collect bribes in exchange for a pass grade, and may go as far as punishing students who do not want to participate in this behavior. This is deplorable, unprofessional, and a direct result of neglect on the part of government and university administrators to meet the financial needs of the staff. As mentioned earlier, 40% of university positions and 60% of polytechnic positions are vacant,  and this is a result of poor representation of the teaching profession because of the way the educational system has been administrated. There are so many unemployed graduates, and there are so many vacant teaching positions. Yet most of them will not seek out teaching jobs because of a sense that the job cannot meet their financial needs.
  4. The curriculum should be upgraded to reflect current needs of the society at large, and the expectations of the job market. Many graduates are ill prepared for the profession in which they seek. This has resulted in a high rate of unemployment, because potential employers feel that they are not qualified and require too much on-the-job training. Many corporate institutions hire international experts to manage multiple aspects of their businesses and operate the machines used in production. These are positions that could have gone to Nigerians if the educational system prepared students for such roles. Approximately 60% of recent university graduates are unemployed, this is significant and unfortunate. Universities need to update their curriculum to include internship opportunities for their students especially in courses such as healthcare, law, engineering, and business. Internship opportunities help bridge the gap between the classroom and professional world, and provide opportunities for students to build their experiences, resumes, and establish relationships with potential employers. Universities should form liaisons with established alumnus who are willing to take on interns. Students can rotate during holidays if the location of the internship opportunity is too far from the school campus.
  5. Upgrade and ensure the availability of necessary amenities including lecture halls and materials, libraries, research laboratories, and computers etc. These amenities are essential for effective delivery of educational content. The maintenance and provision of some of these amenities can be funded directly by the federal government, the institution, or from donations by philanthropist. It is often noted that some schools establish libraries or labs, but do not fund, update, and maximize its use, thereby allowing these costly endeavors to become obsolete. The concept that “a stitch in time saves nine” should become the motto that drives maintenance of institutional amenities. Once infrastructures are allowed to decay, it cost so much more to rehabilitate or build new ones, compared to the cost of fixing small parts immediately when it breaks down. So this outlook should be adopted for the long-term benefit of saving money while ensuring the availability of educational amenities at higher institutions.
  6. Work-Study programs are necessary to help build supporting staff for the effective administration of university processes. Work-Study programs provide opportunities for students to earn stipends, while helping meet the needs of the institution. In most universities in the developed world, students can apply and work in various capacities throughout the school campus. There are some great campus positions that can be occupied by qualified students, including tutoring and mentoring, leadership and project management, library upkeep, sales persons at school shops etc. These offices require management by a qualified, paid administrator, but students can serve as assistants and help stabilize the workforce. Compensation for students may come in the form of bi-weekly or monthly stipends, or percentage reductions in the cost of their tuition. Each institution can choose the method that is most convenient for them. The overall purpose of these programs will be to ensure that the institutional workforce is adequate, while minimizing the budgetary cost of hiring additional staff.
  7. Each university should have a program that sponsors and promotes individual research and innovation by their students. There are so many talented youths in Nigeria, but very few have the platform to develop and showcase their talents. Universities can establish such platforms, and work in partnership with the government and philanthropic organizations to help students  publicize their research discoveries, innovations, and other productions. if well promoted, some of these innovations can lead to major opportunities for the students and provide spotlight and more patronage for the institution.
  8. Tuition at public universities should be maintained at a reasonable rate to ensure that most students can afford tertiary education. The school can also provide partial or full scholarships for exceptional students from funds donated by philanthropists. Overall, the experiences and quality of education provided by an institution will determine the success of its graduating students, the popularity of the school, as well as the number of alumni who are willing to contribute to continued growth and maintenance of the institution.
 Written by Dr. Idongesit Udoh
Reference
Clark, N. & Ausukuya, C.  (2013). Education in Nigeria. Information obtained from wenr.wes.org>Africa.

 

Addressing the Challenges (Secondary Level Education)

The challenges of secondary level education are much more complex than that of primary schools. This level of education consists of 6 years of learning (3 in junior secondary and 3 in senior secondary schools). This is where students begin to identify interest areas, and the direction for higher education studies. Majority of schools begin to streamline students into areas of interest such as science, arts, and economics once they begin senior secondary school (http://www.ibe.unesco.org/).

At the end of secondary school, students take the Senior Secondary Certificate Examination (SSCE), which are either administered by the West African Examination Council (WAEC) or the National Examination Council (NECO). An average grade of C6 or better is necessary for consideration for admissions to public universities in Nigeria (Clark & Ausukuya, 2013). However, a good percentage of students are unable to meet this target for core courses such as mathematics, English, and particularly sciences, resulting in delays in admission to higher institutions.

To address these concerns, it is necessary to identify the problem areas and holes within the academic curriculum that limits students’ comprehension of certain courses. Starting off with notable failure in sciences, lack of sufficient infrastructure for laboratories and inadequate training of teachers have been identified as primary causes. Science cannot be effectively taught in abstract form. Students need to feel, experiment, and engage in bringing what they learn to life. I remember attending Federal Government College Odogbolu from JS1-3, and being taught computer science without actually touching the computer. One day the teacher took us to the computer lab and all 100 or more of us who were in that class gathered around him as he showed us each part of the one computer that was in the office. Of course majority of students could not see due to the crowd, and just stood there until the session was over.

How can students learn computer science without well-equipped computer laboratories for practice? How can they learn sciences such as chemistry and biology without a science lab for experiments that can clarify some of the theoretical information provided by the teachers? How can they begin to use their imagination and develop interest in research if what they are learning in the classroom has not been applied practically to improve their understanding of the process? This issue is primarily caused by limited funding, and it is exacerbated in public secondary schools, which are funded by the state government.

Some private secondary schools are well equipped, but most public schools are lacking, despite the fact that students still pay fees to obtain their education. Therefore, as part of the movement to improve education in Nigeria, this sector of education must be addressed with the understanding that adequate academic preparation at this level, ensures more success in WAEC/NECO, and in higher institutions. There are several factors that need to be addressed, and these are listed below:

  1. Secondary school teachers need adequate training in their designated courses, and should be sponsored for teacher training programs, conferences, and other professional development opportunities. Private schools have the responsibility to provide this for their teachers, but public schools need government funding to implement it.
  2. There is need for rehabilitation of existing structures, and development of new structures to accommodate the increasing number of secondary school students in Nigeria. Overcrowding of classrooms limit the effectiveness of teachers, as students may not be able to ask questions as they need to, and there is less engagement.
  3. Laboratories are a must. They are absolutely necessary to effective science education, and should never be optional. Even if the lab is small, students can be divided into small groups, with each group taking turns to learn and work in there, and the complexity of the practicals should correlate with their educational level. The lab teacher must be well trained and certified in maintenance and handling of the laboratory.
  4. The Ministry of Education should look to unify the examination board. Instead of WAEC or NECO, there should be one examination board. This will allow for standardization of the SSCE, and upgrading of the question bank to reflect what is currently taught in schools. In addition, the school curriculum should correlate with the expectations of the SSCE. Schools should provide practice sessions to prepare their students for these exams, in order to reduce the failure rate.
  5. Textbooks are essential to students’ understanding of the subject and should be integral to what is taught in the classroom. Some schools, especially private schools tend to make students purchase several textbooks for each course-work, but the semester can come to an end with a good number of these textbooks never being used in the classroom. This is a big waste of money for parents, and it prevents students from understanding the value of actually studying the information available in textbooks. Therefore, I propose that each school should choose one or two comprehensive textbook for each course, and actively teach from it to allow students the opportunity to comprehend the subject beyond the limited information that might be provided by the teacher. For students in public schools who may not have the funds to purchase some textbooks, it is the responsibility of the school to provide a library, where all the textbooks recommended for the academic year are made available. These students can take turns to read or do their homework with the textbooks, and return it to the library. Students who have completed the academic year can be encouraged to donate their old textbooks to the school library for a small stipend. This can reduce the cost of funding the library, and help increase the availability of textbooks for the upcoming school year.
  6. Teachers must be adequately paid. Teachers who are compensated for their work tend to have more commitment towards their work, which trickles down to how students are taught. As stated earlier, public secondary schools are funded by state governments, and salary for teachers should be exclusively set aside each budgetary year without fail. Our government officials cannot be living in opulence, while teachers go to work with empty stomachs without assurance of how they will meet their families’ needs.

We really have to reorganize our priorities as a nation, because where we invest our resources is where we will see results.

 Written by Dr. Idongesit Udoh
References
Clark, N. & Ausukuya, C. (2013). Education in Nigeria. Information obtained from wenr.wes.org>Africa.
United Nations Educational, Scientific and Cultural Organization (UNESCO). World Data on Education 2010/2011. Information obtained from http://www.ibe.unesco.org/).

Addressing the Challenges (Primary Level Education)

Primary level education is a universal right that every child deserves. This level of education focuses on children ages 6-11, and seeks to develop their basic capacity to function in the society with the ability to read, write, count, and communicate effectively. Primary education consists of basic courses including English, Mathematics, Science, Social Studies, Arts, and Civic education (http://www.ibe.unesco.org/).The purpose is to help children develop their minds, ability to think and ask questions, and interest in learning. Primary level education should be funded nationally in order to ensure that every child has an opportunity to read and write regardless of their parents’ socioeconomic status.

Some parents can afford private primary education for their children. However, for those children who will have to depend on free public schools, the government must fund these schools and ensure that the curriculum provided is standard, meets the child’s educational needs, and maintain a conducive learning environment. All public primary schools should have basic amenities including classrooms, chairs, tables, and resources for teachers to use and teach. These items are fundamental to a meaningful learning environment, and should be upgraded and maintained from time to time to prevent decay.

To improve training of teachers and curriculum upgrade, the government (state/local) should fund at least one annual teachers’ free training program for public school teachers. The program should be hosted by experts, with a focus on improving teaching methods and effectiveness, upgrading the curriculum, and maximizing children’s potential. This program should also offer certificates of completion that validates those who participate. Private primary schools should be able to sponsor their teachers to attend training programs. However, for poorer private schools that may not be able to fund the program for their teachers, the government should subsidize a portion of the training cost, in order to maximize participation.

Written by Dr. Idongesit Udoh

Arise Nigeria, Arise !!!

There comes a time in human existence when a group of people have to choose a path. Either stay the course and continue on the path of struggle, mediocrity, and further destruction, or take a stand and fight to redeem the nation and leave an inheritance for future generations. Nigeria is at that crossroad, where we risk losing the value of the democracy we obtained in 1960 if we continue to stand and watch as the nation is being stripped of its identity, and the future more uncertain.

The question we all have to ask ourselves is this; how did we get here? We got here because of negligence on the path of leadership and citizens to look out for the well-being of all, rather than a select few. We got here because we failed to adopt a culture of maintenance and diligence towards the preservation of our national treasures. We got here because despite the blessings we have in natural resources, we failed to seek understanding on how to manage our resources and maximize our revenues. We are here because at so many instances we lacked vision, direction, and passion for our people and nation.

Chief Seattle once said “man did not weave the web of life; he is merely a strand in it. Whatever he does to that web, he does to himself.” What are we doing to our web of life as Nigerian citizens? Are we destroying it? How are we contributing to the challenges we face as a nation? Are we willing to become a part of the solution? What is the limit of our compassion? Are we able to see those who are suffering because of the failed systems in the country? Can we see that the young are most affected, and their futures more bleak? How about the poor children in the villages who do not have enough to eat on a daily basis, and may not have an opportunity to obtain an education? Are they not deserving of a brighter future? Think of our broken down educational system, particularly institutions of higher learning. What will it look like in the future if not fixed today? We can also speak of millions of youths who have completed higher education but remain unemployed. How will they grow and contribute to society, if they have no platform to build their skills and display their talents?

Chief Seattle went on to say “take only memories, leave nothing but footprints.” This statement speaks to the fact that what we do today determines the Nigeria that our children and grandchildren will inherit. Are we creating footprints? Will our footprints lead to a destination that is greater than where we started in 1960? We have to understand that many of the great policies and social institutions we admire in foreign countries were envisioned and implemented by leaders who saw opposition and challenges, but pushed through to establish something that made their nations better for the citizens. Most of these leaders did not see the full manifestation of their vision while in office, but they left traceable footprints that enabled incoming leaders to continue to improve on what was started, allowing the changes or projects to stand the test of time.

The president just launched a “change begins with me campaign.” It does not matter what our political affiliations are, this campaign should speak to the core of all Nigerians. What part are we going to play in our communities and our nation in order to establish the changes we want to see? Look around you. Do you see schools in your community with broken amenities that can benefit from your donation? Have you gone to your local healthcare facility recently? What is lacking that you have the power to provide or help improve? Can our elected leaders begin to value the lives and experiences of those who voted them into office? Will our leaders ensure that our resources are not diverted, misused or wasted? Can we seek to maintain transparency and accountability to our nation and the future of our children? Will our business men and women commit to provide quality and efficient services while maintaining honesty throughout?

As a doctor, are you ready to deliver ethical care within the limits of your expertise and provide timely referral and transfers for complex cases that need a higher level of care? As a senior nurse with years of experience, are you willing to mentor your colleagues and bring structure to the way nursing care is delivered at your facility? Will our teachers rise up to inspire and mentor students, teach them to value integrity and respect the rights of their fellow man? Can our students commit to careful use and maintenance of the structures in our schools? As a person with great wealth, can you go back to your Alma Mata, and pay some of the salaries of a group of teachers and professors who may not have been compensated for their work for several months?

Let us start today, stand for the truth, stand for one another, stand for our children and their children. Let us stand for the identity and future of our nation. We all have our roles to play in this movement. We can do so in our communities or advocate in the corridors of power. We have a shared responsibility to take back the values of our nation, and rebuild our Jerusalem. Our contributions to bring the changes we want to see may be small or big, but we must not underestimate the impact we will create, as we all drop a piece of goodwill in our web of life, and watch as our web becomes stronger and redefines the color of our tomorrow.

written by Dr. Idongesit Udoh

About Us

dreamsformypeople.org is an interactive blog that provides a platform for individuals of Nigerian decent to share in the understanding of Nigeria’s challenges through thorough discussion of complex social issues facing the nation, and provide ideas that can be initiated at grassroots level, with the goal of alleviating some of these challenges.

Mission

Our mission is to inform, educate, and inspire a generation of Nigerians that are committed to finding their roles in building the nation, and maintaining social responsibility at the community, state, and national levels.

Vision

We seek to empower Nigerians to take responsibility, raise awareness within their sphere of influence, and begin to create the changes they want to see, through community service, philanthropy, advocacy, and policy making.