Poverty great challenge in combating asthma, respiratory infections – Uba

Dr Chiwuike Uba is an economist, governance expert, and the Chairman, Board of Directors Amaka Chiwuike Uba Foundation (ACUF), a non-governmental organization promoting quality and affordable healthcare, especially asthma and respiratory diseases eradication. In this interview with PAUL OKAH, he speaks on the Foundation’s efforts in achieving better breathing for Nigerians, government intervention in disease control, among others.

Your organisation is involved primarily with managing asthma and other diseases. What factors would you say militate against proper diseases management in Nigeria?

Inadequate infrastructure, poor/inadequate policy and legal frameworks and environmental pollutions occasioned by institutional and governance dysfunctions are some of the key problems in managing asthma and other diseases in Nigeria.

In addition to weak institutional capacity in managing asthma, Nigeria’s healthcare system lacks functional data management system to capture and statistically map the prevalence, morbidity, and mortality rates of diseases in Nigeria.

Whereas the available data indicate that 15 million Nigerians are currently with asthma and this number is projected to increase to 100 million by year 2025, this statistics may not be accurate due to the lack of functional data management system.

Unfortunately, there are no clear concrete steps being taken by the government to address this key challenge to health care management in Nigeria.

Government has done little or nothing to close the wide gap between the recommended standard healthcare that asthma patients ought to receive and Nigeria’s health environment, despite the high costs for managing asthma and the increasing asthma prevalence, morbidity and mortality rates.

Can’t the government approve a specific national policy and asthma management guideline so as to reduce avoidable deaths as a result asthma?

The lack of essential human and infrastructural resources at primary health care centres, tertiary teaching hospitals, federal medical centres and state hospitals are yet to be addressed by the government.

In fact, it appears the situation is worsening by the day. Nigeria’s health insurance scheme is very weak and a reflection of the gap between Nigeria’s health policy and health care financing structure. Whereas the 2014 Act made provision for the establishment the Basic Health Provision Fund to be financed from the Consolidated Revenue Fund, budget allocation to health has never met the 15 per cent annual budgetary allocations to healthcare that Nigeria committed to under the African Union Abuja Declaration of 2001, and the financing regime attached to the National Health Act has since not been activated.

So, more funding would help in realising ACUF’s objectives in organising the conference?

Funding is critical to the implementation of any programme, initiatives and/or projects. No doubt, we could have done more at the conference if we had more funding support. In fact, due to lack of funding support for the conference, I withdrew 25 per cent of my Contributory Retirement Savings (Pension) to fund the conference. It is important to state that the annual asthma conference is only one of our programmes.

As part of the overall operational asthma management strategy, in addition to the annual national asthma conference, medical outreaches/missions and other periodic workshops/ seminars, ACUF develops and distributes asthma management toolkit/handbook, facilitate classroom asthma management education and training to schools, churches and other relevant institutions and create asthma awareness, on a continuous basis through live radio and TV programmes. ACUF has provided direct support to over 600 Asthma patients, trained over 2,000 youths on various vocational, technical and leadership skills and reached out to a larger population through the Foundation’s periodic workshops, seminars and live radio/TV phone-in programmes on asthma and respiratory diseases management.

The implementation of these programmes costs a lot of money and we sincerely need financial support. People can donate equipment, medicine, their network, time, service (as volunteers) and money to the ACUF Asthma Fund.  The donation will help us to continue implementing the programmes, projects, and activities of the Foundation. Truthfully, we may not be able to do much without financial support from well-meaning Nigerians and organisations.

What should Nigerians expect from ACUF with regards to asthma management?

ACUF will not relent in its mission to improve the quality of life people and a vision of a society with better breathing, better living and a happier, united and prosperous people. In achieving these, with adequate financial support, Nigerians should be assured of continued implementations of our programmes and projects, as it were.

On asthma management, we will continue with our Physicians and Medical Practitioners Asthma Management Education (PMAME), which is periodic meetings and capacity building workshops for physicians and other medical practitioners on asthma and other respiratory diseases management tools. Given that all our programmes are free, subject to funding support, we plan to make the workshops a regional workshop in order to accommodate people from other regions.

In addition to this, the schools’ education and training workshops on asthma management and other asthma awareness and advocacy programmes will continue, as it were. These programmes are geared towards increasing awareness among the community as well as protecting people with the diseases. To achieve the objectives, we will continue to engage the media (electronic, print and social media), production and distribution of handbooks, manuals, newsletters and fact-sheets and facilitation of conclaves with champions/asthma advocates, religious and traditional institutions to create asthma and respiratory diseases awareness.

In addition to the Voice and Accountability Programme (VAP), people should expect the continuation of our monthly Youth Development and Leadership Workshop Series (YouDaL) geared towards empowering youth to succeed through working, learning, thriving, connecting and leading. Finally, the theme for the 2020 Amaka Chiwuike-Uba Annual National Asthma Conference is “Growing Right: Delivering Innovation, Equity and Quality in Health Care Services” and the conference will hold in July 2020.

ACUF recently held its 2019 Asthma Conference, what was it all about?

The 2019 Amaka Chiwuike-Uba annual national asthma conference held on 18th July, 2019, in Enugu, Nigeria, with the theme “Better Breathing, Better Living: The Role of the Environment and Governance”, had the overreaching goal to brainstorm, identify, and share information on the linkages between governance, environment and its impact on better breathing and living in Nigeria.

The aim was to increase awareness of asthma and other respiratory diseases burden, improve asthma and other respiratory diseases management behaviours in both short and medium term; reduce asthma and other respiratory diseases morbidity and mortality rates in the long-run. To achieve these aims, the conference, therefore, served as a solution-based civic platform for all stakeholders (including members of the legislature, the executive, asthma patients and their families, medical practitioners, caregivers, pharmaceutical companies, private sector operators, international donor organizations, members of academia, civil society, media, etc) to, not just identify access to health care challenges, but make evidence-based policy recommendations on ways to improve governance, environmental governance outcomes, facilitate and promote access to healthcare (especially asthma and other non-communicable diseases diagnosis, treatment and control) in Nigeria.

Can you say you are satisfied with the outcome of the conference?

Contextually, if outcome is defined in terms of the quality and mixed participation, quality of speakers, paper presentations, discussions and post-conference feedback from both the participants and speakers, I would say I am 100 per cent satisfied with the outcome. In all honesty, I am not just satisfied with the recorded attendance of over 800 persons, but their patience and commitment to acquiring new knowledge.

It is not easy to have such a number of persons devoting a whole day for a conference, staying in a place from 8am to about 5pm. I am so grateful to the Chairman of the Conference, Prof. Onyebuchi Chukwu and all the speakers for their presence and support.

As part of the conference outcome, I have been to other conferences as a keynote speaker, speaking on asthma and asthma management. My invitations were facilitated by persons who attended the asthma conference. No doubt, others may have also had an opportunity to step-down and deepened the lessons learnt from the conference; hence, educating others on the management of asthma and other respiratory diseases.

Furthermore, I will also say I am satisfied with the conference outcome when viewed from the expected outcomes from the conference, as it were. Evidently, there is increased stakeholder awareness on asthma and various options for asthma management and demand for the health sector reforms in various states. Over 90 per cent of the conference participants reported that it highly impacted on their knowledge of asthma and an improved interest and action in removing asthma triggers in our environments.

In addition to revealing the latent data weaknesses and inadequacies in the various hospitals (private, state and government) and government MDAs and shared understanding of the role of the government (governance) and the environmental exposures on asthma and other respiratory diseases management in Nigeria, there is improved and enhanced capacity of both the state and non-state actors to promote environment governance and friendly environment for asthma management.

Over 90 percent of conference participants reported that the conference impacted positively on their competence to manage asthma and over 84 per cent of non-respiratory specialist doctors and other medical practitioners while agreeing that there are professional practice gaps amongst non-pulmonary specialists in the diagnosis and management of asthma, made recommendations on how to address the identified gaps.

The other conference outcome is the development of an action plan and options paper for integrating the environment and governance. ACUF and other stakeholders are currently editing these documents. The options paper is expected to provide for the general governance principles required to influence and inform environmental governance for greater participation, fairness, access to justice, transparency, accountability, efficiency, leadership/direction, and timeliness.

Finally, the outcome on the decrease in asthma morbidity and mortality rate is a long-term outcome. However, the Foundation has established a framework to monitor this expected outcome over time.

How can the ACUF conference influence policy decisions in the health sector?

The structure of the ACUF annual national asthma conference promotes ownership and engenders immediate uptake of the recommendations from the conference for immediate implementation by relevant Institutions.

The conference enhances open government initiative wherein the government and citizens sit together around the table to identify critical challenges, proffer solutions to the challenges and agree to workable and measurable implementation plans to address the identified challenges. The adopted approach does not only influence policy decisions but also establish a mutually reinforcing mechanism that encourages demand for accountable, responsive and capable government and quality service delivery. These are achieved through the participation of all the stakeholders through the entire process of the conference, from planning, hosting and post-conference activities.

In addition to the above, the action plan and policy brief ensuing from the conference is usually deployed as an education and advocacy materials after the conference. We follow-up the decisions reached at the conference with direct engagements with relevant arms of the government but at the national and sub-national levels.

Many speakers identified poverty as a problem in managing asthma and other diseases, can you say you agree with them?

Yes, I agree completely with the speakers’ identification of poverty as a problem in managing asthma and other diseases in Nigeria. Treatment costs are enormous problems for many people with asthma and this has made asthma treatment difficult; hence the increase in asthma prevalence, morbidity, and mortality rates. It is more difficult in Nigeria where the costs of treatment are from out-of-pocket expenses with no medical insurance. Asthma costs the UK health service at least £1.1 billion each year and the US economy more than $80 billion per year. Evidently, the costs of managing asthma are huge and not something to be left for asthma sufferers and their families to bear alone. The burden is even worse and made more painful given that Nigeria has the largest extreme poverty population of over 86.9 million Nigerians living in extreme poverty. With a minimum wage of N18,000.00 (the approved N30,000.00 is not yet effective) and the unemployment rate hovering over 23 per cent, it is difficult for most Nigerians to access and afford medical care in Nigeria. Do you know that the cheapest inhaler used for asthma treatment costs N1,450? Other asthma inhalers costs between N7,600 – N41,200.00, while asthma tablets cost between N10.00 – N750.00 per tablet. Can Nigerians can afford this?

In addition to poverty, weak institutions, inadequate infrastructures, policy frameworks and environmental pollutions occasioned by weak and poor governance, are problems in managing asthma and other diseases in Nigeria.

What advice do you have for Nigerian government with regards to asthma management and health funding?

Asthma is not a death sentence. Proper diagnosis, identification of asthma triggers, avoidance of the triggers, adherence to doctor’s medication prescriptions and regular check-up are very important in managing asthma.

If we can reduce air pollution, we can reduce the prevalence of asthma and other respiratory diseases. Exposure to environmental pollution is linked to increased hospitalisations, disability, infertility and early death from respiratory diseases, cardiovascular diseases, stroke, lung cancer and diabetes, damage to the brain, nerves, liver, kidneys, as well as communicable diseases.

Over 8.8 million extra deaths annually are caused by air pollution with over 4.4m deaths caused by household pollution.

As I stated earlier, asthma medications are very expensive, sometimes unavailable and unaffordable, resulting in huge burden, mortality and morbidity to those with asthma and even their families; especially in Nigeria, where poverty and unemployment rates are so high. Therefore, prompt action is needed from all stakeholders, governments, pharmaceutical companies, NGOs, private sector organizations, among others to address the challenges. Government needs to approve and implement national policy and asthma guidelines, comprehensively apply asthma Standard Case Management, implement national asthma programmes with up-to-date public registries, improve access to affordable quality-assured essential asthma medicines, ensure that essential asthma medicines are on Nigeria’s Essential Medicines list and ensure that they are free, subsidized or reimbursed.

In addition to working with NGOs to provide education and training on asthma for parents, patients and health personnel, government can increase funding by developing and implementing insurance schemes, which will allow patients to access and buy asthma medicines. Together, we shall beat asthma.

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