It was a gathering of stakeholders from across the globe who converged to attend the 5^th AfHEA Biennial Scientific Conference on Primary Health Care (PHC) as a Foundation for Universal Health Coverage (UHC).

The event, held in Accra, Ghana, West Africa from where it was born, out of the International Health Economics Association (IHEA). It was a thrill for me as an aspiring Health Policy & Systems Research (HPSR) expert coming from the mainstream media.

Against the backdrop of the jollof rice ‘war’ between Ghana and Nigeria, I was very excited to moderate a session involving an all Ghanaian team with dons like Prof. Irene Agyepong, Dr. Isaac Morrison and Dr Charity Sarpong, among others who presented papers and were panellists. They spoke on a per capita payment system as a viable strategic purchasing option for assuring universal access to PHC in Ghana.

This edition which was also the 10^th anniversary of AfHEA was themed ‘Securing PHC for all: the foundation for making progress on UHC in Africa,’ with global actors and stakeholders in the industry presenting papers on their findings from their various researches, health ministries, organisations and governments. The goal was charting the way forward for Africa to achieve UHC by 2030.

Supported by Ghana’s Ministry of Health, The World Bank, World Health Organisation Africa Region, iDSI Health, Bill & Melinda Gates Foundation, the Korean Government and UNFPA among others, AfHEA 2019 spotlighted the challenges people in Africa face every day in accessing healthcare and what financial protection or its non-existence they are having to contend with.

It was also a forum which brainstormed on how innovations, new research and political will power could advance UHC and change the narratives to ensure health for all, even at the lowest level of healthcare provision.

Representatives from the various ministries of health, researchers and other stakeholders from across the continent spoke on their respective journeys towards achieving UHC reflecting on the challenges and successes in the various papers and discussions they presented and/or participated in.

In his speech at the opening ceremony of the conference, Ghana’s Vice-President, Dr. Mahamudu Bawumia said the government has approved the operationalization of Zipline’s drone technology to deliver drugs and blood to rural areas in the country. This is in a bid to ensure a cost-effective approach of providing quality healthcare.

He said, “Next month, Ghana will begin the introduction of drone technology in the delivery of medical supplies. We are taking a lead from Rwanda who pioneered this in Africa. Once we start our drone delivery service will be the largest in Africa. We are also innovating means of healthcare delivery to reduce cost and be as efficient as possible. We are trying to rely on technology to help us be more efficient and also be cost-effective.”

This initiative which is expected to start in April 2019, challenges other African leaders, especially the ‘giant’ of the continent, Nigeria, where communities would rather resort to traditional self-treatment methods than visit primary health centres where they are very often met with the lack of medicines.

The five-day event started with pre-conference workshops on grants writing, applied health economics in Africa, tracking progress towards UHC and promoting informed choices in young people as per sexual and reproductive health.

One of the takeaways at the opening plenary was from Dr. Asamoah Bah, former WHO Deputy Director General who made an analysis of global health in comparison to fashion where styles trend until they later go out of vogue. Bah took participants down memory lane where the snag was Primary Health for All by the year 2000 which was reflective of the different campaigns that have happened over the years with regards to UHC and PHC and why it is important for them to be sustainable rather than fade out of style.

Nigeria’s Dr. Emmanuel Meribole highlighted some of the country’s achievements in the last five years regarding UHC, the national health act and the basic healthcare provision fund among others. The plenary while raising questions on accountability and the need for it, also called for a critical view on policies and programmes beyond simply adopting them.

The conference also featured sessions on hospital management and financing, public health research issues, the influence of cultural practices on the spread of diseases and health systems strengthening among others.

This year, there was something new to AfHEA introduced by Leanne Brady, a Health Policy & Systems Researcher, for which she was also recognised at the conference gala night. This was a session on decolonising health policy and systems research to include and exclude a number of elements like allowing for more Low and Middle Income Countries to participate more actively and decolonising colonial residues which still determine actions in former colonies as well as the sensitivity of choosing locations for confabs that would benefit the global south.

As part of the celebrations, individuals along with the local organising committee were honoured for their efforts towards pursuing the ideals of AfHEA at the gala night which was held at the famous Labadi Beach Hotel. They included among others, the local organising committee for successfully organising this year’s outing and Leanne Brady for suggesting a new angle to the usual AfHEA format.

Prof Di McIntyre, the Executive Director of IHEA received the François Diop Award for lifetime contributions and achievements in health economics.

At the closing session there was a call for more youth engagement at the forum with emphasis on not ignoring them on the road to UHC as their health concerns should command their own context and shape the conversations surrounding it.

Some of the takeaways from the conference included the need for more synergised working structures among all stakeholders from policy makers to financiers, academia, health economists and the media.

According to Prof. John Ataguba a health economist at the University of Cape Town, South Africa, purchasing is often forgotten within health financing. “Purchasing is an aspect of health financing that Nigeria needs to begin to look at strategically. Strategic purchasing is basically ensuring that decisions made in terms of purchasing services have some underlying principles in ensuring that you cut down cost and also ensuring that you can get services as less expensive as possible but of adequate quality to the last person who uses the services.”

While there were over 450 registered attendees at the outing this year from about 40 countries with Nigeria having the largest number of members, it is hoped that lessons taken away will not gather dust only to be cleaned out and rehearsed in time for the next biennial.

Tanko Al-Makura is governor of Nasarawa State, in northern Nigeria and lives each day with a scar inflicted on his “life and psyche” by Lassa fever. This is what he knows of the disease that has constantly killed Nigerians every year since 1969.

A male child among seven sisters, Al-Makura took to hawking cassava flour as a vocation because “that’s what I saw my sisters doing,” he recalls, standing in front of an audience of Lassa fever researchers and experts at the Abuja event held on January 16 and 17, 2019. “It inculcated in me a feminine and domestic instinct of care and nurture.”

It is the contact that puts many families in danger of contracting Lassa Fever every year.

Al-Makura was a 37-year-old father when his sons were diagnosed with a fever. One son was clenching. That “feminine instinct as a father” took hold and Al-Makura wanted to ensure his son didn’t cut his tongue between clenched teeth. “I got bitten on one finger. It was a small cut, no blood,” he says. “I didn’t know that was the beginning.”

The son died, the other one survived but developed profound deafness. Five days later, Al-Makura developed classic symptoms—fever, headache, stomach pain, tight chest, erratic breathing. The treatment by trial and error went on for two weeks. “There was no improvement, despite the fact that I was in a teaching hospital,” he says. “Linking my symptoms to Lassa Fever was my saving grace.”

Oyewole Tomori, a virologist who’s worked on Lassa Fever since it was first identified in 1969, made the diagnosis and insisted Al-Makura be sent off to a facility equipped to deal with a haemorrhagic fever like Lassa. The only hospital suitable in 1990 was in Lagos. A blood sample was sent to the US Centre for Disease Control in Atlanta, 9728 km away.

Fifty years on, the infrastructure for dealing with a yearly epidemic has changed; there is more knowledge about Lassa Fever; hundreds of articles on knowledge, attitudes and perceptions of Lassa fever have been published; the science is better understood. Yet the disease’s outbreaks continue to strike annually, claiming lives.

From 1969 to 1978, the outbreak was confined to four states in Nigeria. Nearly every state in the country has seen an outbreak in the last 50 years, and with it, a rising number of deaths. Between 2009 and 2018, only Zamfara has not reported a case.

The Nigeria Centre for Disease Control (NCDC) has already declared an outbreak this year after 60 people across eight states were confirmed infected with the Lassa Fever virus in the first two weeks of January alone.

Despite the tons of knowledge-attitude-and-perception articles [nearly 160 papers were presented at the conference] published on Lassa Fever, the basic route of infection continues to make the country vulnerable. Environmental hygiene, personal hygiene, handling food materials, handling sick loved ones, handling patients—it is all in the mix.

In the lead up to declaring an outbreak, NCDC warned: “Lassa fever is an acute viral haemorrhagic illness, transmitted to humans through contact with food or household items contaminated by infected rodents. Person-to-person transmission can also occur, particularly in a hospital environment in the absence of adequate infection control measures. Health care workers in health facilities are particularly at risk of contracting the disease, especially where infection prevention and control procedures are not strictly adhered to.”  It advised the Nigerian public to “focus on prevention by practicing good personal hygiene and proper environmental sanitation. “Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households, and other measures to discourage rodents from entering homes. Hand washing should be practiced frequently. The public is also advised to avoid bush burning,” it added.

Al-Makura didn’t know any other way to handle his ailing son years ago. He and his doctors were at risk.

“I was later informed that my infection was the result of the bite from my son,” he recalls. The outcome of Al-Makura’s bout with Lassa Fever is profound deafness. He’s been using cochlear implants since 2000 to process sound, “although with some distortion,” he says.  “Every day, I have to wear a hearing aid for 18 hours.”

Every year, this message goes out: “Health care workers are again reminded that Lassa fever presents initially like any other disease-causing febrile illness such as malaria; and are advised to practice standard precautions at all times, and to maintain a high index of suspicion. Rapid Diagnostic Tests (RDT) must be applied to all suspected cases of malaria. When the RDT is negative, other causes of febrile illness including Lassa Fever should be considered. Accurate diagnosis and prompt treatment increase the chances of survival.”

A lot needs to shift in manner toward Lassa fever.

“You are killing your loved ones, your doctor is killing you and the doctor is committing suicide from utter disregard for infection prevention and control,” says Tomori.

“My country is a country waiting for the lion to finish yawning before deciding to run,” he said. “Once it is down yawning, its ready to pounce on you.”

Infograph Credit: National Centre for Disease Control (Nigeria).

The event which was a joint conference organized by WHO, the United Nations Office of Outer Space Affairs (UNOOSA) – the UN agency responsible for promoting international cooperation in the peaceful uses of outer space and assisting developing countries in using space science and technology, and the Government of Switzerland with support from the European Space Agency (ESA) came up following an agreement that a dedicated flagship event was needed in 2017 “to review and consider space cooperation for global health related activities, and to bring together the space and the global health communities to also explore potential future projects and collaborations”.

This was in a bid to strengthen the ongoing processes in the lead up to UNISPACE+50 and to address the thematic priority focusing on global health, with the aim to identify gaps, needs, opportunities and recommendations for inclusion into the report prepared for UNISPACE+50 on this thematic priority. UNISPACE+50 marks the Golden Jubilee anniversary in 2018, anniversary of the first United Nations Conference on the Exploration and Peaceful Uses of Outer Space (UNISPACE I), which was held in Vienna, Austria in 1968.

The UNOOSA website also states that “The Committee on the Peaceful Uses of Outer Space (COPUOS) at its fifty-eight session in June 2015 endorsed a plan of work (A/AC.105/L.297) for UNISPACE+50 to be undertaken by the Office for Outer Space Affairs, the Committee, and the subsidiary bodies of the Committee.”

My instant reaction upon reading the conference title, was where in the world do these two connect? How do they relate? What do they have in common or to do with one another?

But then I said, “hang on, wait a minute! How can you ask about their relationship? What technology helps with weather forecasting and those cyclone forecasts you hear on the news? Yes, this is weather and maybe environment but really, where do they connect for global health? In this regard, what health forecast have you heard about in Nigeria? Or what health campaigns do you know have happened in Nigeria based on health forecast?”

I decided to apply to have these questions answered, and to also explore ways in which I could use the lessons learned in the course of my work as a journalist and an advocate for healthcare for all regardless of the location.

UNISPACE+50 has seven thematic priorities (TP) centred on how space technologies are being used to fulfill the mandates of the UN. The conference in Geneva focused on TP5 after which it was titled.

UNOOSA Director, Ms. Simonetta Di Pippo explained that activities of the agency are channeled to meet the requests of member states who are also telling UNOOSA not to tell them what to do or how to do it but to convince them on why they need to invest in space activities in the first place. She said more states in the last three years have been asking to become members, which has led to an increase in membership.

Hans Troedsson, assistant director general, acting in-charge for WHO’s Health Systems and Innovation Cluster, gave on the site examples from his 27 years in the WHO. He said, “we don’t want to make the same mistakes as we did with the MDGs” adding that outer space technology “offers appropriate and affordable tools which we need to use to achieve UHC which is one of the priorities in public health today and tomorrow.” He added that  it is key is to have communication where there are more skilled staff in the health sector. Troedsson also said  it is ignorant to say space has nothing to do with health. “It is not a given, it is something we have to explore and put in some intellectual capacity looking at what means and tools, cooperation and how we can use them.”

While participants from the West mostly recounted successes from their experiences with space technology in health, the successes for developing countries weren’t so resounding.

In India, although the technology has been welcome, putting it to use hasn’t been without hitches as Chandan Kumar of Save the Children, India acknowledged.

According to Kumar, the lack of proper infrastructure in the rural and interior villages as well as the massive gap in the availability of medical staff in such areas, pose the greatest challenge to the efficiency of the technology.

Kumar, who was optimistic that space technology if properly channeled would bring about a turnaround in global health, advised that for the technology to improve the provision of healthcare services, “we should identify context specific solutions and adapt the technology based on the real needs of the community”.

As remarkable as this event was, the conversations and participants need to be broadened and involve more actors like global health practitioners, young app developers and the media whose field and technical experiences would be valuable inputs to move the impact of the campaign forward.

Dr. Prestige Makanga, a lecturer at Surveying and Geomatics Department, of Zimbabwe’s Midlands State University, said the idea isn’t one he has sold to the government. He said, “My work has been done in the context of a clinical trial that is still ongoing. No results have been shared with the government.”

Responding to a question on how data received differed from the realities on the ground and how he has worked around resolving the disparities, Makanga said, “I only used a derivative of satellite data in the form of precipitation and flooding. These were historical records and were validated from newspaper reports.”

Just as some of the recommendations at the end of the conference were arguing for more inclusion in the conversation and simplifying the technology to be more accessible, Kumar added that it also had to be user friendly.

After being in a room  full of scientists and data experts for several days in a row, I can pretend to have some level of expertise as I watch the news about how Texas prepared for hurricane Harvey, one of the few hurricanes identified by a male name . I recognize the satellite maps and geotags (a term I first heard at this forum) and suddenly feel like I’m on familiar territory as I can see how space data is directly helping to preserve lives and prevent what may otherwise have been an (even) more disastrous event without pre-knowledge.

Besides journalists being participants of the Global Symposium on Health Systems Research (HSR) can they also be empowered to report Health Policy and Systems Research (HPSR)?

They usually begin with “Dear Colleagues,” “Dear Worthy Friends,” “Top of the day to you, I trust you are doing well,” and other such catch phrases. These are followed by several lines of flattery about how the journalist has been so good and diligent with reporting their events and promoting their course. Then comes the real reason for the (rather unappealing) introductory lines – “please kindly find space in your highly esteemed platform to use our press release… possibly in your next edition. Always grateful for your enduring help…”   (grin grin)

Sometimes I read through the press release and see how much of the meat has been lost and how embarrassed I would be to put my byline to a story emanating from such a release.

A couple of weeks ago, I  wrote about making journalists an integral part of the HSR symposium and why it is important for them to attend the event as active participants, not just merely covering it for news sake.

I did a search on Google for ‘media promoting hpsr’ and everything media that came up was social media. That terrified me a bit as I wondered for an instance whether social media had become an apt replacement for mainstream media. They are complementary but can’t replace them (even if Donald Trump thinks otherwise).

Rather than send a press release for an event, is it possible, and of course where permissible, that journalists are embedded from the onset in the program and have a chance to experience for themselves first-hand what the program is about?

In a way, like young researchers, many of us journalists could also use some coaching and training before a ‘state of the art’ HPSR symposium kicks off.  Health Policy and Systems Research is not a generic health genre and requires some level of informed perspectives, knowledge and expertise to do justice to reporting anything in the field. These are attributes that take quite some time before one gets a knack for them. If I do it correctly now, at least sometimes, then I’d say the forces are with me but I would not turn down the chance to be better equipped (even if I have been fortunate to attend the Vancouver symposium and can now immerse myself a bit further in HPSR during my IHP internship in Antwerp).

Academic sounding as HPSR may be, journalists can bring it down to the basics using a bottom up approach with human angled narratives that still do justice to the whole essence of advocating resilient health systems. And trust me, you would get more than the four paragraphs a run-off-the-mill press release would deserve. Such collaborations could even churn out a series of connected reports on a particular HPSR topic.

Working with journalists to produce HSPR-focused newspapers, books and related media could be way more impactful than solely relying on official blogs, websites or social media.

There could be online courses, there could be courses organized before (or even during) conferences – why not skills building workshops/days for journalists as well, before the symposium starts? Communities of practice could also organize training programs for journalists in their locations and/or regional and national hubs.

The impact of such goes beyond the newsroom and news publications. If done well, communities which are the targets of HPSR in the first place, will also end up healthier and safer. Certainly if you believe in the vital role of the media (to boost accountability, raising awareness of rights, …) to help egg on UHC in countries around the globe, as the UHC 2030 movement is gaining momentum, under the leadership of Dr. Tedros and many other UHC proponents, it’d be wise to also think a bit through the role media can play in the movement, and how to properly equip journalists. Such collaborations would be a beneficial way to address the gaps in journalists’ literacy and understanding of health policy and systems research and the need intensify the advocacy for strengthened health systems. Trained journalists can also play a role in bridging the gap between HPSR researchers and policymakers, thus playing a vital role in knowledge brokering towards more effective use of evidence in policy and practice.  Granted, journalists never want to be fully embedded, but you get the idea at least.

So what about a couple of workshops in Liverpool on ‘how to explain intersectionality, complexity, realist evaluation, strategic purchasing, … and other fancy HPSR jargon in a no-nonsense way to audiences across the world?’ Or perhaps some brainstorming on how to empower journalists on HPSR at the upcoming WHO symposium on health financing in Montreux, and ‘Public Financing for UHC: Towards Implementation,’ in early November?

We’re not all Joe Kutzins or Agnès Soucats… and chances are, our readers even less so. But understanding the UHC whizzkids’ logic a little better will certainly not hurt the global and national UHC case.

Jubilations and a few concerns

With the emergence of Dr. Tedros, Africans like Nigerian Health System and Policy Specialist, Dr. Ejemai Eboreime see Africa as now well-positioned to define and lead the next phase of global health development. The continent has already demonstrated its capacity to take on this challenge.

For Eboreime, the jubilations were not on the platform of sentiments but on a track record of Tedros’ competence in improving equity in access to healthcare as Ethiopia’s health minister (2005-2012). While there was a global effort to improve Africa’s health systems, Ethiopia met the Millennium Development Goal target of reducing child mortality by two-thirds, two years early.  HIV infections, malaria and tuberculosis mortality also declined by 90%, 75% and 64%, respectively.

Eboreime says, “The world has for a long time attempted to improve health systems in Africa using interventions synthesized outside the continent by “experts” alien to the uniqueness of African challenges. Also, interventions in Africa have been “cut and paste” approaches that assume that “all Africa is the same,” thus one size fits all.  Dr. Tedros, being African, understands the contextual nuances of Africa and has demonstrated that African nations have the potential to lead their own development using homegrown and context-adaptive approaches.” Eboreime adds, “The rest of the world can learn a lot from African experiences towards improving health systems globally. I think Africa’s jubilation is premised on this understanding.”

Still, there are a few concerns. One of them being, according to Jean-Paul Dossou, from the Republic of Benin, “some people may feel that Africa is now leading a relatively “weak” organization with a poorer impact, globally” (as compared to earlier decades, when WHO was uncontested or at least less so than in the 2000s era of global health initiatives). Dossou adds: “This is the main challenge Tedros will need to address – getting WHO back in the driving seat.”   True, easier said than done.

UHC, the Abuja Declaration & global health diplomacy

In April 2001, the African Union countries met and pledged to set a target of allocating at least 15% of their annual budget to improve the health sector and urged donor countries to scale up support. This brought about what is now known as the Abuja Declaration. A ten-year appraisal by WHO (in 2011) showed that not all countries had implemented it – and yes, that’s an understatement.

On whether Tedros’ emergence might bring a change in this regard, Eboreime says, “Numerous economic and political factors are responsible for this. I think WHO, under Dr. Tedros’ leadership, will be better positioned to understand the varying contextual factors impeding implementation of the Declaration and provide advocacy and technical support towards improving funding for health, particularly as it applies to ensuring universal access to quality healthcare, which is the mantra upon which he won the election. However, given the contextual challenges of African nations, UHC is the foundation upon which any meaningful development can be premised in Africa. It should therefore be a non-negotiable priority agenda for countries under WHO-AFRO.” That surely seems to fit with Tedros’ view: as he made clear earlier this week, he considers UHC as “the captain of the team.”

Eboreime adds that “Primary Healthcare has been identified as the ideal vehicle through which UHC can be achieved, particularly in Low and Middle-Income Countries. Despite its importance, PHC is often deprioritized, underfunded and understaffed, making it the weakest link in health systems of many countries. Borrowing words from Dr. Tedros, I would say, “No more excuses!” Now is the time to strengthen PHC if we are to attain UHC and indeed the SDGs. I am confident that the new WHO leadership will infuse a new spirit in revitalizing PHC in African nations towards attaining quality care for all.”

Yibetal Assefa, an Ethiopian Fellow at the School of Public Health, the University of Queensland, Australia, complements: “UHC is based on both national commitment (see above) and global solidarity (developed countries should allocate 0.1% of their GDP to global health). This requires a lot of advocacy and negotiation. Dr. Tedros has developed skills in global health diplomacy from his post as the foreign minister in Ethiopia.”  Tedros’ recent tour in the US and his attendance of the G20 summit are certainly promising signs of global health diplomacy skills.

Public health specialist Prof. Faustin Chenge, from the Democratic Republic of Congo, hopes, like many Africans, that with an African WHO boss,  a fresh and dynamic approach will be used to improve healthcare availability and the health and well-being of Africa’s populations.  “He will push and support reforms in the governance, funding, and provision of healthcare towards UHC.” Even though UHC tops the DG’s “to do” list, with the current state of UHC on the continent and its non-availability to most of the citizenry, Chenge reckons, “Achieving UHC in many African countries during Dr. Tedros’ term is, of course, not feasible.  But he will certainly be able to push and support reforms in order to help all countries realize more of their health potential. I think the ambition will not be to achieve UHC, but to put UHC on track in most African countries. This is possible and feasible.”

With transparency and credibility still a major issue in health structures, Professor of Virology and President of the Nigerian Academy of Science, Oyewale Tomori emphasizes: “People mention that there are competing interests which make it impossible to achieve UHC. Unfortunately, in many African countries, the competing interests are corruption and lack of accountability.”

WHO is a global organization, but Africa is a key focal area

Dossou hopes Tedros will acknowledge that “WHO is a global organization, and Tedros should thus see his position as a global one even if he is from Africa.” “Equity and fairness should drive his policy; he may give more attention to Africa, because of the share of global burden of diseases of Africa.  But a mere Afrocentric approach based on his continent of origin would be a political mistake that may further weaken WHO and reduce its legitimacy and thus its capacity to help effectively address the key challenges of the continent.”

Tomori agrees with Dossou on this issue, also emphasizing that Tedros is not the head of an African health organization, but of a global one. Against this backdrop, he argues that establishing and sustaining a reliable and efficient disease surveillance system is another priority that the new DG should consider in order to prevent and control emerging and re-emerging diseases.

He says, “Africa is notorious for the occurrence of severe disease outbreaks and an impotence in effectively controlling these outbreaks. Given the inter-play of different issues- economic, social, cultural, environment- in health, we need to adopt the “One Health” concept in finding solutions to the health problems of Africa which calls for interdisciplinary collaborations and communications in all aspects of healthcare for humans, animals and the environment.”

Like others, Tomori also preaches against a one size fits all approach: “Given that health problems and challenges vary from country to country, there can be no one size fits all and I am sure the new DG is aware of this. In any case, to be effective and successful, the objectives of UHC must be tailored to solve the health problems of each country.”  Tedros indeed already expressed himself similarly in recent speeches.

Some final advice for Tedros

Assefa who has known Tedros for 16 years, and perhaps knows him best of all the experts we contacted, suggests a few more ideas to help the new WHO boss  achieve a healthier, productive and prosperous Africa, as well as a healthier world.

He says, “Health is a multi-sectoral issue. It is important that he works with other stakeholders and sectors so that they can work together for the good health of the global population.

“He needs to bring the lessons from Ethiopia – health systems strengthening, primary healthcare (including community engagement), and leadership commitment.”

African emergency preparedness and response, is also key, says Assefa who thinks Tedros can play a critical role in bringing WHO-AFRO and CDC-Africa together so that there will be a synergistic and collaborative effort in emergency preparedness and response in Africa.

Propagating more collaboration, Assefa says, is vital. By way of example, he thinks it’s important that the WHO boss also uses the different WHO offices in the North and South so that lessons from one region will be disseminated and utilized in others. This would include, in the SDG era, a South-South, North-South and South-North flow of information and best practices.

Finally, Assefa also acknowledges Tedros will need the goodwill and collaboration of other global health initiatives and sectors (given the many complex – even “wicked” – SDG era health challenges). There again, early signs are promising.

So here you go, Dr. Tedros. Good luck on a – no doubt difficult but rewarding –  journey!

At the time, I had no clue what HSR meant but my journalistic alter ego took charge as I began going over in my head, how many possible story ideas I would get from there, people I would meet, possible collaborations I could engage in and so on. Also, knowing I would meet people coming from countries with similar situations and challenges as mine is laden with, I looked forward to the opportunity of listening to them and hear their success stories.

One of the most visible things to me in the first few days was how they all seemed to know one another.  I would be in conversation with a WANEL member and almost faster than sound, see an expression of excitement on their face. Initially it was rather incomprehensible, as I silently wondered what part of what we were talking about was joke enough to provoke such a smile, squeal or laughter. But in no time, I saw the reason. They had seen a familiar face they shared a common history with, working to bring about better and sustainable health systems. This was a regular occurrence and I was curious to understand how in only three editions of the HSR, these people had built such a network and sense of community. The warmth of this close-knit family was contagious, in spite of the rather chilly autumn weather outside.

I had my moments of stardom and absolutely relished the quizzical looks on the faces when I introduced myself as a journalist. For reasons not entirely clear to me, the average health systems researcher admires two kinds of “ health systems” people: policymakers and, to a lesser extent perhaps, but still, journalists (even if they probably don’t trust them fully  ).  I also enjoyed responding to their question and at some point began reeling it out to them before they asked – “A journalist, what’s a journalist doing here. Come to think of it, I never imagined it was an important part of this conference.”

For those who were interested in carrying the conversation further, it was quite heartwarming when I saw that they realised how very alike our goals are and the fact that whether researcher, decision maker, practitioner, activist or journalist, we are all working together and fighting for the same cause – better lives for our people.

Whilst I was happy to see the HSR camaraderie, I wondered why only mostly researchers and people in health systems enjoyed such a bond at the HSR. Why were the (handful) journalists I met, there mainly to cover the event, while attending sessions and not playing any key roles (except for a few plenaries with moderating journalists.) I was certainly glad I could contribute by moderating a WANEL panel.

There are no boundaries where it comes to what HSR as an idea, movement, phenomenon can stand and strive for. I have a hunch however, that the HSR community would be better heard and be more impactful if team HSG made a conscious and deliberate effort to include more journalists in the programme, not just to cover sessions (including plenaries) or to moderate sessions with HPSR stars, old and emerging ones.  These are generic roles expected of journalists.  But they’re also rather unadventurous. What about inviting journalists who for instance can follow a Kabir Sheikh for a day or a Lucy Gilson? Or a journalist who can further investigate issues raised at the symposium or one who can query policies and budgets armed with verifiable information gathered at the Symposium? Or better still, invite journalists who when they report can share stories of successful models that have worked in other parts of the world and can be applicable to similar settings. What about the possibility of organizing interviews at the HPSR symposium where tough dreaded questions are posed to big wigs in global health policy & HPSR circles, something like an ‘HSG Hardtalk’? I can already see  the crowd cheering, whenever the big shot tries to avoid a question. Wouldn’t it be lovely if the (pitbull) moderator blurts out ‘fake news!’, whenever Bill Gates or Tedros make statements better suited for the MDG era than the new SDG/planetary health era?

Or how about making provisions for a ‘Politico style’ journalist to move around in Liverpool, trying to find juicy news and the like? Politico was at the World Health Assembly this year, and Liverpool isn’t far from Geneva (even if Britain feels a bit remote nowadays). You could also think of a ‘pool of journalists’ who would go from session to session to shake things up, whenever “death by PowerPoint” is a threat.

Plenty of options so let’s break away from the routine and add some tonic to the mix of researchers, academics, policymakers and students. Journalists will give the right balance to that mix.

Just as funders, decision makers, civil society and other symposium participants all have roles and slots to spread the(ir) gospel, the mainstream media should be afforded the same. We’re good at creating buzz and noise and isn’t this what UHC 2030 (urgently) needs? Moreover, there isn’t a more appropriate time, now that the new WHO DG, Dr. Tedros’ first priority is UHC.

I now introduce myself as a journalist writing human angle stories on development issues with a solutions-based approach. I tend to tell my stories better if I can include hard data which I represent in charts, graphs and infographics. However, it was only after attending the Vancouver confab the significance of this dawned on me. Another benefit of the conference is that I am still writing stories out of the ideas I got from there.

Although I was told that the last HSR symposium made a bit more effort than previous editions towards having (more) journalists attend the symposium, I still think more can be done. It seemed to me that the main role of journalists who were in attendance, was to promote the event through platforms made available by the organizers like the Global Health TV, rather than actually be a part of the symposium in the sense that they sat on panels, had a spot in the market, etc.

Recently, on June 13, 2017, it was reported that a Christian group wants law that lets them discriminate against disabled people because “they believe church services could be disrupted by people with mental illnesses.” Wouldn’t it be more impactful if for instance journalists through their various platforms lent their (amplifying) voices to a vital subject like Global mental health: Under-represented at international global health conferences? – especially considering that mental health is a global issue in dire need of attention?

Although blogs are one way of getting the message out, greater media participating and involvement can make a bigger impact. One might also consider a structural collaboration between HSG and The Conversation.

Our call for resilient health systems would be near deafening enough for governments, politicians policymakers and other actors to want to listen even more. But journalists are also excellently placed to push a bit, and ask the hard (even uncomfortable) questions, which researchers often can’t (or won’t) ask or because they’re just too nice (just kidding  ). Journalists tend to be a bit nastier (a bit more like the real world, quoi). Nevertheless, we’re all on the same side guys, we’re only using different vehicles for our advocacies in order to arrive at our destination.

Also, journalists provide a faster turnaround time, are often “jacks of all trades” and can bring in a broader perspective to issues which other stakeholders often tend to view from the perspectives of their narrow field of expertise.

Drawing from the wisdom of professor emeritus, Prawase Wasi, M.D. and his analysis on the Triangle That Moves The Mountain, as researchers and the academia mostly create the knowledge, let journalists carry on the social movement and learning, and provoke the political involvement. To kick start a real UHC movement, globally and nationally, journalists are indispensable in this ‘triangle’. Even in the era of ‘fake news’ – perhaps even more so in the era of fake news.

As Liverpool 2018 lurks around the corner and the agenda for the programme is being planned, it would be nice to bear in mind and make provisions for significant roles for journalists to play, lead and participate in sessions, formats. Perhaps journalists could even be mainstreamed in the programme.

According to Wasi, “Knowledge derived from research must be translated into forms and languages that can empower the public.” This is what journalists know how to do best.  We’re more likely to follow up on the issues. And don’t worry: we’re not all pitbulls!

Hauwau Gana, born prematurely on October 7, 2016 lost her mother, Hadiza, to delivery complications. For two weeks she was in an incubator at the National Hospital, Abuja until she was released to her father, Baba, who signed an undertaking to pay up her medical bill within a given period. From the onset keeping up with her dietary requirements was a problem: he had three other children and made a meager income working as a commercial motorcycle operator in Masaka, one of Abuja’s unofficial IDP camps. Hauwau died on March 5 due to ill health, probably accelerated by complications from malnutrition. Her death was a rude shock for her father still mourning his wife.

The situation is not very different for the first one thousand days in the lives of other children in Abuja’s IDP camps, as was revealed during a visit to the New Kuchigoro IDP camp.

A sight that immediately hits the eyes upon entering the camp is of children eating unripe cashew or hugging branded bottles of water which now carry kunu (gruel made from guinea corn). They sip on this or their mothers are seen feeding it to them.

Baby holding on tightly to his kunu

Ramatu Ayuba, 23, from Gwoza, Borno State, gave birth to her son on October 8th, 2016. Unlike her two previous pregnancies, where she nursed her children exclusively on breast milk, she said she’s not producing enough, “That is why I give him kunu. I don’t know why the milk doesn’t flow. Back in my village, breastfeeding was one of the things we were encouraged about during antenatal, but not here.” Ramatu knows nothing about maternal or infant health.  Her son has never been ill and has received BCG inoculation and polio immunization. To enhance her milk flow, the housewife said, “In the morning I ate kunu, I am making some beans and pasta for lunch and will have rice for dinner. When I drink tea, I put some milk in it. Then my milk flows a little and I feed my son. He hasn’t yet started eating solid foods; I mostly feed him kunu.” Ramatu said that her son would have some kunu again for dinner and didn’t have problems with bowel movement.

Most of Nigeria’s official and identified unofficial IDP camps are found in states like Borno, Adamawa, Yobe, Taraba, Edo and the FCT among others where measures are being taken to curb malnutrition.  But apparently they are insufficient.

IDP data collected by NGOs and UNICEF-supported teams in Yobe and Borno states, say the proportion of children with global acute malnutrition [as identified by mid-upper arm circumference (MUAC) and/or oedema] is over 80%. These initial assessments provide an indication of increasing levels of acute malnutrition.

The United Nations Office on the Coordination of Humanitarian Affairs (OCHA) estimates 300,000 children in Borno State alone will suffer from severe acute malnutrition over the next 12 months and up to 450,000 in total across Adamawa, Borno and Yobe, if adequate assistance is not received.

The situation is dire for IDP such as Maryam Amos, 25, who had her first child on March 8th, 2016, in her room, assisted by a midwife on the camp. She considers herself fortunate to have participated when NGOs gave health talks and antenatal services. “They advised us to eat a lot of banana, fish, oranges, fruits and groundnuts. When I gave birth they advised me to eat a lot of energy-giving foods, meat, vegetables and milk among others, to help my breast milk. But I can’t afford some of them, so I make do with what I have,” Maryam recalled. The Gava, Borno State indigene added, “I was advised to breastfeed my baby and what kind of foods to eat to help my breast milk. I breastfed him exclusively for 11 months and introduced artificial food as he approached 12 months. He has rejected the foods like kunu. Today, he’s eating it. He often suffers stomach ache and I’ve had to take him to the camp’s infirmary, where he was given medication. The illness isn’t completely cured yet.” Maryam, who considers her son to be healthy but for the stomachache, wants him to become a teacher, “I would like him to teach others the way of life.”

Malnutrition among IDPs has been news and despite government’s claims to be on top of the situation, the statistics are still on the high. The Borno Emergency Management Agency (BEMA) reported malnutrition-related deaths of about 450 children, ages one to five, in 28 IDP camps. BEMA said, “about 6,444 severe cases of malnutrition were recorded in the camps, 25,511 have mild to moderate symptoms.”

According to UNICEF, the 2017 nutrition requirement for IDPs is $40, 217 105. In 2016 it said 97,777 children under 5 years received micronutrient supplementation.

The significance of a child’s first one thousand days is a phenomenon many are unfamiliar with. Dr. Bamidele Omotola, a nutrition specialist at UNICEF, Abuja, shed light on the issue:  “The first one thousand days of life start from conception within the first one day of the pregnancy until the child is two years old. The pregnancy normally lasts for nine months, which is 270 days, and the two years at an average of 365 days per year multiplied by two, which is 730, plus the 270 days give the 1, 000 days that we refer to.”

Omotola said, “When a woman realizes she’s pregnant, the first thing is to go to the clinic, register for antenatal services and from there her health will be managed including the regular pills for blood because in pregnancy she needs to feed for herself and for the baby inside her. She must take what we refer to as adequate diet. She must take at least three meals and encourage herself to eat.” He described the components of an adequate diet as having animal source which is what a lot of people call protein, beans, cereals, maize, rice, millet, sorghum roots and tubers like yams, cassava, coco yam, plantain, vegetables, fruits and oils.

On how this relates to women in Ramatu’s situation he said, “Ideally, the fact that you’re IDP does not imply that your diet should be compromised. Also, knowing full well their circumstances and that they depend on what food donations they can get, whoever is making such donations must be aware of the need of such women.”

Speaking on what it portends for children being fed kunu in their first one thousand days, he said, “A child less than six months must be completely breastfed. “The mother should be supported to adequately breastfeed. After six months that child would require other foods in addition to breast milk. Those other foods must come from the varied sources. But nothing stops a mother from mixing the gruel with groundnut paste or soya beans and oils to enrich it.  “When there is no such mixture, these children are the ones who eventually become emaciated and may become severely malnourished because they won’t grow well and their mental formation is compromised and this has implications for such a child in later life. By the time a child is two years, 90 percent of his brain formation is attained.”

Malnutrition is a plague bedeviling children across Nigeria and the situation is twice as bad with internally displaced children. The cause of children suffering stunted growth has in several cases been traced to poor nutrition in their first 1, 000 days of life. “It is irreversible and associated with impaired cognitive ability and reduced school and work performance,” UNICEF says.

It is a crisis that needs immediate and clear-cut government and international intervention. Not just in Nigeria, by the way, as headlines of the past months sadly point out. With insurgency ravaging countries across the world, the humanitarian crisis is deepening by the day, provoking ripples of problems, with malnutrition and famine being on the forefront. Earlier this week, UNHCR, the UN Refugee Agency, warned that the risk of mass deaths from starvation among populations in the Horn of Africa, Yemen and Nigeria is growing.

Since Boko Haram’s seven-year terror in Nigeria, about 2.6 million have been displaced. All in all, “In northern Nigeria, seven million people are now struggling with food insecurity and need help. The situation is particularly bad in parts of Borno, Adamawa and Yobo states where by June it’s expected that some 5.1 million people will be in Integrated Food Security Phase classification levels of between 3 and 5 (worst).”

Let’s hope help doesn’t come too late for all these people in dire need.

Children eating unripe cashew is a common sight in IDP camps

PHOTOS: Adie Vanessa Offiong