Dr Chiwuike Uba is an economist and governance expert. He is also the Executive Director of Amaka Chiwuike Uba Foundation (ACUF), a non-governmental organisation with a bias for the diagnosis and treatment of asthma and respiratory diseases. In this interview with PAUL OKAH, he revealed that asthma patients spend over N6 trillion annually on medications, the challenges of the Foundation in achieving its objective of better breathing for Nigerians, as well as the forthcoming 2019 ACUF annual national asthma conference.
On the 2019 ACUF confab
The 2019 Amaka Chiwuike-Uba Annual National Conference with the theme Better Breathing, Better Living: The Role of the Environment and Governance is unique and is coming at the right time. First, we are faced with challenges ranging from being rated as one the most polluted countries in the word to a country grappling with a lot of problems associated with other governance issues. Most diseases are associated with environmental and governance issues. The 2019 conference is, therefore, expected to x-ray the linkages between the environment and governance and its impacts on health management as well as make policy recommendations on ways to ‘deal’ with the identified challenges.
The annual conference is a platform to discuss national issues, especially health and related matters in an evidenced-based approach. The annual conference is not a talk shop. The workshop provides policy alternatives and action plan on how to solve the identified challenges. Having said this, it is important to note that each year’s conference is distinct, but also built on the successes of the preceding conference. The 2017 conference was anchored on the theme: “Improving the quality of life of people: The Role of Timely and Accurate Diagnosis and Management of Asthma.”
Fortunately, one of the outcomes of that conference was the identification of the environment and governance as key determinants in the management of health issues in Nigeria. The 2019 conference, therefore, will look at issues related to our environmental governance and other governance issues, as they affect the health management in Nigeria. Oil flaring has been going on since I was born, despite its attendant health and economic consequences. Secondly, the speakers at the 2017 conference are mainly experts in respiratory diseases, but the 2019 conference has a mix of speakers with expertise on respiratory (non-communicable) diseases, governance and oil and gas management. Participation in the 2019 conference is also expanded to accommodate arrays of professionals and experts.
First, as I earlier indicated, the theme for the 2019 conference slated for July 19 in Enugu flows from the outcome of the 2017 Conference. Nevertheless, the conference theme was chosen in consideration and recognition of the impact of environment and governance on the quality of life of people. Pollution is a major environmental health problem affecting everyone; contributing heavily to the burden of diseases: from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. Whereas people may have a greater ability to modify indoor environmental exposures, in most cases, they do not have direct control over outdoor pollutant concentrations. A clear example is the continuous and continuing gas flaring in Nigeria as well Nigeria’s rating as one of the most polluted countries in the world. The control of both indoor and outdoor environment exposures, therefore, becomes the key ingredient and responsibility of government and outcome of governance (either good or bad).
According to the World Health Organisation (WHO), air pollution is responsible for more than 12 million deaths per year. The achievement of the Sustainable Development Goals (SDGs) targets —SDG 3 (Good health and well-being), SDG 6 (Clean water and Sanitation), SDG 7 (Affordable clean energy), SDG 13 (Climate action), SDG 14 (Life below water) and SDG 16 (Peace, Security and Strong Institutions) is dependent on the environment and governance outcomes. In a nutshell, governance is core to a sustainable environment and development. We recognise that Nigeria’s economy will be improved if people live a healthy life with a guaranteed access to quality and affordable health care. This is in addition to the conversion of the wastes from gas flaring and pollution’s to wealth. Green economy is realisable in Nigeria.
Health care policies
Government is not doing so badly in formulating health care policies in Nigeria. However, we have not fared well in the implementation of the policies we have in place. There seems to be no genuine efforts or political will to implement the policies. For instance, Nigeria has National Health Laws and policies that are not implemented. The national health insurance law implementation is still at its lowest, making out of pocket expenses the major form of paying for medical bills. It may shock you to know that those with asthma spend over N6trn annually as out of pocket expenses for their asthma management. Notwithstanding the inadequate or non-implementation of existing health laws and policies, there is need to have new policies and guidelines. Most importantly, given the increasing number of those suffering from asthma and other respiratory diseases, there is urgent need to have a national guideline and policy on asthma management and control in Nigeria. The policies should take care of environmental, building, physical issues on asthma management in schools, hospitals, public buildings, etc. Most schools and public buildings in Nigeria have ventilation issues: hence, contributes to the increasing mortality and morbidity associated with asthma and other respiratory diseases in Nigeria. Asthma is an epidemic and should be treated as an emergency.
Projection for asthma patients
As at the date, this projection of more than 100 million Nigerians having asthma in 2025 has not been reviewed downwards by the World Health Organisation (WHO) and other authorities on health across the world. Let me state here that the above estimation is conservative. First, because Nigeria does not have good data management culture; this is made worse by Nigerians spirituality anchored on ‘it’s not my portion’ and ‘God forbid’ mantra. How many Nigerians visit the hospital when they are sick? On a lighter mood, if not for periods of incarceration, would you have known some of our big politicians are asthmatic?
Therefore, ACUF asthma awareness is geared towards helping people know the status and manage their asthma very well. This is achieved through our free medical lung measurement tests and sensitisation programmes. Obviously, our work, in addition to helping the citizens to know their status, ultimately, may have led to a reduction in deaths associated with asthma. Do you know that over 1, 000 persons die from asthma daily? Unfortunately, our government is paying little or no attention to this menace.
We carefully chose our speakers for this year’s conference based on their passion for good governance, inclusiveness, access to quality and affordable healthcare and their expertise in the areas they would be speaking on. For instance, the choice of Prof. Onyebuchi Chukwu as chairman of the 2019 conference is mainly predicated on the achievements he recorded as Minister for Health in addressing issues related to non-communicable diseases in Nigeria. Prof. Tunji Olaopa is a renowned public policy expert, having spent years as a career policy maker and a professor of public policy. Our own BBOG convener, Dr. (Mrs) Oby Ezekwesili, is a core governance expert and good governance advocate. Prof. Benjamin Uzochukwu is a consultant public health physician and Prof. Gregory Efosa Emerhbor is a consultant respirator and Chest Physician. In addition, we have Prof. Rowland Ndoma-Egba who is also an administrator and health professional par excellence. In fact, all the speakers – Ademola Henry Adugun, Dr. Adaeze Ayuk, Larry Oguego – are known authorities in their areas of specialties. For a conference of this nature, you need people who have passion and genuinely working for the progress, prosperity and renaissance of our dear country, Nigeria.
Health minister as major patron
We are immensely grateful to the current Minister of Health, Prof Isaac Adewole. In addition to participating in the 2017 conference, he promoted and authorised our partnership with the Ministry of Health to organise the annual conference. The current minister has done and is doing so much in ensuring the implementation of the mandates of the Ministry of Health. We are also hoping that he will confirm his attendance to the 2019 conference. ACUF is enjoying the support of the current Minister of Health and indeed, value the support of the Ministry of Health under his leadership. We will surely be honoured to have his presence at this year’s conference.
I should rather ask you; why not Enugu, why Abuja? As a country, it is important to always promote the different states. For us at ACUF, Nigeria is one. The committee may decide to host next year’s event in Zamfara. Every other state needs to develop same way Abuja is being developed. First, hosting the conference allows participants to access other locations in Enugu. It would help to improve the economy of the state as well. Secondly, for logistics purposes, Enugu presents a better environment for planning the event. Finally, it is our little way of recognising our host state and the Enugu state’s commitment and active role in promoting access to quality healthcare, as evidenced in the States Health Sector Reform Bill. As I said earlier, hosting of the conference is rotational, depending on logistics and other considerations as may be determined by the organisers from time to time.
Safety is one of the considerations for choosing Enugu state as the host for this year’s conference. As you may know, Enugu is one of the safest cities in Nigeria, according to crime statistics. This report has been corroborated by many security chiefs in Nigeria. The Police Service Commission Chairman, Alhaji Musilu Smith, confirmed this in November 2018. In addition, according to travel advisory of the USA embassy, GOV.UK and other international agencies, Enugu is one of the states that are classified as ‘safe.’ Therefore, there should be no fear of safety for anyone who is attending the conference. More so, special security arrangements are being put in place for a successful conference. We enjoin all to register and attend the conference.
Govt, organisations’ support
Nigerians are yet to imbibe the culture of giving for charity. Our philanthropy most times is on the building of churches and doing those things that receive immediate clapping/hailing from those present. Currently, ACUF has not received any financial support from government and/or organisations. Few family members and personal friends have supported us in their own little ways. Nevertheless, from inception of the Foundation in 2016 till date, the activities, programmes and projects of ACUF have been funded from my personal savings. In all honesty, it has not been easy on me and my children. Sometimes, we agree to go hungry to make sure we meet the needs of others through ACUF. Painfully, we are unable to do all that we propose to do; as a result of financial challenges. It is our hope that people will begin to support the Foundation financially by making donations and getting involved in fund raising for the Amaka Chiwuike-Uba Foundation (ACUF). We indeed need financial support.
To achieve the objective of Better Breathing, Better Living for Nigerians requires collective efforts and commitment of everybody – the government, the citizens, and development partners. As I earlier noted, air pollution is responsible for more than 12 million deaths per year. Notwithstanding the availability of different respiratory diseases drugs, significant numbers of patients are still suffering from respiratory diseases while a significant number still die from the disease. For instance, an estimated 75% hospital admissions for asthma and as many as, 90% of the asthma deaths are avoidable. Poor diagnosis is one of the reasons.
Therefore, continuous medical education is necessary for medical doctors. Interestingly, ACUF, in collaboration with other organisations, is already facilitating such specialised training for medical doctors. Asthma is already an epidemic! The global burden of asthma is already substantial in terms of mortality, morbidity and economic costs.
According to the recent Global Burden of Disease (GBD) study, Asthma is estimated as the 14th most important disorder in terms of global years lived with disability. Asthma, therefore, should be among the top priorities of Ministries of Health, development partners and CSOs when assessing health priorities, allocating resources, and evaluating the potential costs and benefits of public health interventions.
We need continuous collaboration of the Nigeria Medical Association and other allied organisations and the Ministry of Health, as well as financial support from Nigerians, grant-making institutions and development partners, and finally, the collaboration of the National Assembly in putting in place, laws that will promote better breathing and better living in Nigeria. Nigerians also need to start visiting hospitals for proper diagnosis and management of their medical conditions.
As I stated previously, management and control of asthma requires collective efforts and commitment of all – governments, asthma patients, CSOs, and international development and multilateral institutions. Having identified accurate and reliable data as one of the key challenges in asthma management, governments should, by way of committing to research that increases the understanding of asthma, its causes, and leads to improvement in management; collect counts of hospital admissions (public & private) for asthma among children and adults. In addition, health authorities (MDAs) should report rates of asthma deaths in children and adults. This is necessary to monitor progress in asthma care, and as an early warning of epidemics of fatal asthma.
Given the high mortality associated with environmental pollution, government’s policies on reducing tobacco consumption, encouraging healthy eating and reducing exposure to potentially harmful chemicals, smoke and dust, should be strengthened. Furthermore, coordinated national strategy towards better measurement of the true burden of asthma, improving access to care and improving adherence to asthma management strategies should be established and followed through. This strategy should also include the development of new ways to target and deliver asthma care in diverse health systems and contexts, and gathering of evidence of costs and outcomes, cost-effectiveness, affordability and feasibility.
Asthma is already an important public health issue and should be recognised as such and included in all government actions; including setting up a national programme to improve asthma care in a cost-effective way. Patient advocacy should also be encouraged by health professionals and policy makers to improve asthma outcomes.
Finally, budgetary provisions should be made in the governments’ annual budgets for the asthma awareness and capacity building for health professionals and asthma patients. Other institutions should partner with ACUF in its efforts to improving the quality of life of people. For, together, we shall BEAT asthma.