‘Every level of health needs intervention’

What is SHI about?SHI is Sustainable Healthcare Initiative, where we strengthen health systems.  We do have systems in place but they are not adequate enough to match the needs of the people so we continuously strengthen the system to bring them up to par. I totally disagree with people who say that we do not […]

What is SHI about?
SHI is Sustainable Healthcare Initiative, where we strengthen health systems.  We do have systems in place but they are not adequate enough to match the needs of the people so we continuously strengthen the system to bring them up to par. I totally disagree with people who say that we do not have infrastructure . We do have infrastructure. It’s just that the disease burden is so overwhelming that it crumbles the system.
Every level of the health system needs intervention. Although, the kind of intervention you offer might differ. At the primary level, the intervention might be for basic needs, and major capacity building at the tertiary level where they already have major equipment and co; so it’s basically training. But at the lower level, they probably don’t have any equipment at all. So you train them and equip them with the basic first aid that they need to be able to handle issues at that level.

How long have you been in operation?
We have been in the development sector for over 20 years but SHI came into existence just a little over seven years ago, but we started full operation four years ago.

How many systems have you strengthened till date?
We’ve done quite a lot of work. For instance, we’ve trained over 3,000 health care providers in 18 states in two years between 2011 and 2012, on affordable medicines; ACTm malaria project where we introduced ACTs for malaria as a first line of choice for treating malaria according to the WHO new policy.

We also discouraged the use of monotherapies for malaria treatment.
We have done quite a lot of warehouse renovation and behavior change communication across 18 states. We are currently doing behavioral change communication across the 36 states and the Federal Capital Territory. We’ve also conducted training in about 15 states on the use of rapid diagnostic test kits for diagnosing malaria.

You will notice hitherto once somebody has fever, the first thing they do is treat malaria. Yes, fever is indicative of malaria but it has to be confirmed, most times we not have infrastructure to confirm if that fever is malaria. In the rural areas, it is difficult to find technical people that can use microscope when these facilities do not even have laboratories.
In places where they do have laboratories, maybe they don’t have electricity to power the microscope. So the rapid test was introduced wherein with a simple drop of blood they can test within 15 or 20 minutes if a patient has malaria or not.

Is it true that ACT is developing resistance to malaria?
The ACT we are talking about is not artemisinin alone. Artemisinin is just the base and then there’s another molecule that attaches to it and that’s why it is artemisinin- based combination therapy. So which of the residues is it resistant to? We need to substantiate such. There are lots of people that feel comfortable using mono therapies and they are the ones trying to discredit ACTs. I find such allegation spurious and unfounded. Moreover, it’s not enough to say that a drug does not work, there has to be series of tests conducted to confirm such allegation.

How feasible is it for us to eradicate malaria, especially given the fact that Nigeria is in a tropical zone?
I think it is possible because it is all about behavioural change communication. There’s no way malaria can exist without the possibility of mosquito not coming in contact with man. Once you break the factor, somewhere along the line, there won’t be malaria again.
And don’t forget that because we are in the endemic area, if you do test for malaria now, they will find the parasite in you or me but it doesn’t mean that you have it. But overtime, you can wipe it off. It may take time but I believe that eradicating malaria is possible.

I also recognize the fears that we have because Nigeria alone is responsible for as much as 40 per cent of the global malaria pandemic so you can understand the fears we have but I believe it is doable. This is a country of very resilient people, with the push we are making and with the support from donor agencies and international partners, we are on the right track.
So now, there’s a lot of drive towards prevention, proper diagnosis and case management. These are the key areas. For all of these, there’s proper communication; to let people know sincerely how they can actually get malaria, if they do have malaria, what to do and when they get it, how to ensure they get proper treatment. So with this kind of push, am sure we will surely get there .You will also notice the recent change from the National Malaria Control Programme to the National Malaria Elimination Programme. It is a gradual process but we will surely get there.
 
Many people accuse  health-related NGOs of duplication of roles. For instance, we also have PATHS 11 involved in strengthening the health system, what’s your take on this?
It may seem like it but it’s not. However, I agree with you that all of us can actually become better if we’re harmonized. We are talking about a situation where one plus one will give you more than two, and you’re getting more value than you’re putting in.
But we are actually not duplicating roles because everybody is strengthening a certain portion of the system because there’s no way you can touch everybody at once. But we are touching a particular area, they are touching a particular area and at a certain time, everything will be done.
In fact, it’s not just health strengthening alone. We are into commodities logistics, warehousing and so many other areas. You get one person taking commodities to facility A and you find another person taking probably HIV commodity into facility A. It’s not actually duplication but if you can harmonise such that one logistic partner can take both HIV and malaria commodities into the same health facility, then you can get better value for money. But it’s still not duplication.
Don’t also forget that a lot of organizations have different mandate so their mandate would have to be followed to the letter so it makes life more difficult for harmonization. But development partners are coming together. There’s a development partners group for health basically and they meet regularly once every month and its chaired by the Nigeria’s country representative of the World Health Organisation. We’re looking at how to streamline the activities. We are having a joint annual review to identify gaps within the system and work together with other donor partners. So once we begin to sit on the same table, then we begin to look for the next steps and how to harmonise areas of synergy. Its slow but it’s a step in the right direction.

How does SHI get its funding?
We get quite a lot of funding from donor agencies; most particularly from the Global Fund. We also get some support from the World Bank, Management Sciences for Health, US government etc.
Additionally, we also strive to see what we can actually contribute to the development sector so we look for cost effective way to implement. So if we are given a certain amount of money to do something, we ensure it can be done in such a way that its either we are delivering more than you tell us to deliver or we deliver the same thing you ask us to deliver but with less money. That actually make us the bride of the donor agencies that we partner and that’s why we’re getting more and more popular with them.