VZCZCXRO4599
PP RUEHMA RUEHPA
DE RUEHUJA #2274/01 3241123
ZNR UUUUU ZZH
P 191123Z NOV 08
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 4490
INFO RUEHOS/AMCONSUL LAGOS PRIORITY 0287
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 03 ABUJA 002274 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHA WILUSZ 
USAID FOR GH GREENE, HARBISON, BARTLETT AND AFR/SD HARVEY, AFR/WA 
WAY 
CDC FOR NCIRD/GID/DEEB ERBER 
 
E.O. 12958: N/A 
TAGS: TBIO KISL PGOV SOCI ECON KOCI EAID NI
SUBJECT:  NIGERIA:  WEAK HEALTH SYSTEM HURTING MDGS 
 
SENSITIVE BUT UNCLASSIFIED - DO NOT DISTRIBUTE OUTSIDE USG. 
 
¶1. (SBU) SUMMARY.  On October 9, the acting Supervising Minister of 
Health Mohammad Lawal, who is also the Minister of Labor, held a 
press conference in which he reported on the current health status 
of the nation.  The report, while unrealistically laudatory of the 
ministry's efforts, described a weak health system.  The health 
system is overburdened, under-funded and understaffed to fight the 
major health challenges the country faces, while attempting to meet 
the population's healthcare needs.  President Yar'Adua's quest to 
attain the UN's Millennium Development Goals (MDGs) of lowering 
under five child mortality rate by two thirds and maternal mortality 
by three fourths by 2015, is unlikely to be met without reforms in 
the weak public health sector, and addressing other socio-economic 
challenges that directly or indirectly influence the health of the 
nation.  Ambassador had the opportunity to travel with Lawal on 
November 13 and underscored the need for the GON to do more to 
address concerns over the resurgence of polio in Nigeria, 
particularly the north.  END SUMMARY. 
 
. 
RUDDERLESS MINISTRY 
------------------- 
. 
¶2. (SBU) A leadership gap in the Ministry of Health has stretched 
over six months since the former minister resigned due to corruption 
allegations in March 2008.  While the President released a list of 
twenty axed ministers on October 29 and forwarded to the Senate on 
November 17 (announced publicly on November 18) a partial list of 
new ministerial appointments, he has not yet designated who will be 
carrying which particular portfolios, including that of the health 
ministry.  A ten-page document distributed at the press conference 
outlined the major public health threats as malaria, HIV/AIDS, and 
high levels of infant, child and maternal mortality.  It also 
mentions assistance the GON has received from principal development 
partners and enumerates self-identified accomplishments to date. 
The timing of the press conference was auspicious for what was in 
effect a valedictory effort by Acting Supervising Minister of Health 
Mohammad Lawal.  (COMMENT: The FMOH's press release at the event 
largely provided old and outdated data, lacked any real reference to 
malnutrition as an underlying cause of child morbidity and mortality 
and is devoid of any significant discussion on reproductive health, 
beyond a plan for increasing the number of midwives.  Consequently, 
it is difficult to objectively assess and verify challenges and 
successes.  END COMMENT) 
 
¶3. (SBU) According to the FMOH, malaria accounts for 60% of 
outpatient visits, 30% of childhood deaths, and 11% of maternal 
deaths.  Nigeria also suffers from a very low tuberculosis detection 
rate of 30% (compared to the global rate of 70%) and has a high 
tuberculosis burden with an estimated 380,000 new cases per annum. 
Although the HIV prevalence rate has improved from 5.2% in 2003 to 
4.4% according to the latest GON survey conducted in 2005, a lot 
needs to be done to maintain the declining rate and to care for 
those living with the virus.  (COMMENT:  A 2007 UNAIDS survey shows 
a 3.1% prevalence rate, a figure used by the U.S. President's 
Emergency Plan for AIDS Relief (PEPFAR). Malaria and tuberculosis 
are major public health challenges, which according to observers are 
not being effectively addressed by the FMOH and its state government 
counterparts.  END COMMENT) 
 
¶4. (U) There are 210 anti-retroviral (ART) sites, 263 preventing 
mother to child transmission (PMTCT) sites, and 813 HIV/AIDS 
counseling and testing (HCT) sites nationwide, according to the MOH. 
 Currently, there are 226,000 people on ART, out of 250,000 targeted 
by the GON.  (NOTE:  PEPFAR data shows 263 ART sites, 472 PMTCT 
sites, and 731 HCT sites and nearly 199,758 individuals on PEPFAR 
provided ART treatment.  The disparity stems from the GON's slowness 
to update data.  END NOTE).  Though not highlighted in the press 
release, GON resources have remained to date a small fraction of the 
resources for HIV service delivery efforts.  The vast majority of 
testing and ART treatment is in fact supported by PEPFAR, and to a 
lesser extent, the Global Fund program. 
 
¶5. (U) The GON is also underperforming in curtailing morbidity, 
especially in children under five, from largely communicable 
illnesses, such as acute respiratory diseases, measles, diarrhoeal 
diseases, polio and other vaccine-preventable illnesses.  The GON 
has had success in almost completely eradicating guinea worm with 
only 42 cases in 2007 as opposed to 653,620 in 1988.  The MOH 
expects the disease to be eliminated by the end of 2008.  Reduction 
of child and maternal mortality remains a key challenge, and per the 
ministry's press release, there has been slow progress in reducing 
maternal, newborn, and child mortality due to "poor access to 
 
ABUJA 00002274  002 OF 003 
 
 
medical interventions."  The Ministry has adopted an integrated, 
maternal, newborn and child health (IMNCH) strategy, a care system 
that goes from preconception through pregnancy, child birth, and 
infancy to early childhood, however the strategy has not yet taken 
effect.  In addition, the Ministry plans to introduce a one-year 
mandatory national service for midwives. 
 
¶6. (U) Health experts report the lack of safe and affordable 
medicine and the proliferation of fake and counterfeit drugs 
compound health problems.  Nigeria lacks an efficient drug 
procurement and distribution system, which has lead to the 
flourishing of illegal markets for fake and counterfeit drugs. 
Little is being done to ensure the safety of food, water and 
chemicals used in everyday life, especially in the rural areas. 
Iodine utilization has grown to 98%, a silver lining in an otherwise 
dim picture.  However, challenges remain including the smuggling of 
non-iodized salt and re-bugging of industrial salt as table salt. 
 
 
. 
IMPROVING STANDARDS FOR HEALTH CARE 
----------------------------------- 
. 
¶7. (U) The FMOH is putting together a new national strategic health 
development plan (NSHDP), which is expected to guide the development 
of the health sector.  Between 2001 and 2008, the MOH has 
constructed 570 model primary health centers (MPHC) nationwide and 
equipped them with medical equipment, stock of essential drugs, and 
forms for the collection of health statistics.  The long term plan 
is to have at least one functional MPHC center per political ward 
nationwide. 
 
¶8. (U) The Ministry has also provided training and funding to MPHC 
health care practitioners for the implementation of a community 
based health plan.  It has also developed and is implementing a ward 
minimum health care package (WMHCP) to standardize medical care 
nationwide.  The ministry is also working on developing and 
implementing a manual on the minimum standards for PHC in Nigeria. 
(COMMENT:  The operational and budgetary aspects of this plan and 
the responsibilities between the federal and state levels of 
government have yet to be worked out, and a new child survival and 
maternal child health initiative (expected in 2008) has yet to take 
effect.  END COMMENT). 
. 
INTRODUCTION OF A NATIONAL HEALTH INSURANCE SCHEME 
--------------------------------------------- ----- 
. 
¶9. (SBU) The MOH has a plan to expand access to the three-year old 
national health insurance scheme (NHIS) beyond federal employees and 
members of the armed forces, which currently covers around 2.5 
million people.  The plan is to expand coverage to the organized 
private sector, rural communities, the urban self-employed, 
vulnerable groups such as pregnant women and children under five, 
and prisoners.  Although the vision of providing universal access to 
healthcare is laudable, whether the NHIS has the technical, 
logistical, financial, and management wherewithal to efficiently run 
such a wide and complicated system remains to be seen. 
. 
BIOMEDICAL AND PHARMACEUTICAL RESEARCH 
-------------------------------------- 
. 
¶10. (U) The Nigeria Institute of Medical Research (NIMR) conducts 
biomedical research in the country and helps build human and 
laboratory capacity in the health sector.  It also collaborates with 
medical schools and health institutions within and outside the 
country.  The National Institute for Pharmaceutical Research and 
Development (NIPRD) conducts basic and translational research for 
the development of pharmaceutical products.  The U.S. National 
Institute of Health (NIH) has a working relationship with this 
institute and has funded the construction of a new chemistry and 
microbiology lab completed in 2007.  This lab is being used by U.S. 
and Nigerian researchers for developing potential anti-tuberculosis 
and other agents. 
. 
COMMENT 
------- 
. 
¶11. (SBU) Nigeria faces serious health threats and suffers from a 
weak health infrastructure that is overburdened, under-funded and 
understaffed to fight major diseases while attempting to meet the 
regular healthcare needs of its people.  Access to basic health care 
needs to be expanded, especially in the rural areas.  The lack of 
current and accurate public health data points to a weak health 
information system, a necessary ingredient for crafting and 
 
ABUJA 00002274  003 OF 003 
 
 
implementing appropriate health interventions and policy measures. 
USG assistance through PEPFAR, the President's Malaria Initiative 
and USAID and CDC program funding are making significant 
contributions to contain and curb the ravages of HIV/AIDS, malaria, 
and polio.  Nigeria needs to show much more political and financial 
commitment to address the epidemiological and systemic challenges 
that it faces. 
 
¶12. (SBU) The FMOH's press release largely provided old and outdated 
data, lacked any real reference to malnutrition as an underlying 
cause of child morbidity and mortality and is devoid of any 
significant discussion on reproductive health, beyond a plan for 
increasing the number of midwives.  Consequently it is difficult to 
objectively assess and verify challenges and successes.  The U.S. 
Mission will continue to engage and nudge the GON so that it fulfils 
its stated objective of improving the health of its people and 
achieve its developmental aspirations. 
 
¶13. (U) This cable was coordinated with Consulate Lagos. 
 
SANDERS