Monday 20 June 2016

A STATEMENT ISSUED AT A PRESS CONFERENCE COMMEMORATING THE “2016 DAY OF THE AFRICAN CHILD (DAC)” HELD AT HOTEL SEVENTEEN, INDEPENDENCE WAY, KADUNA ON THURSDAY 16TH JUNE, 2016



PREAMBLE:

The Partnership for Advocacy in Child and Family Health (PACFaH) Project is an innovative intervention implemented by eight leading Nigerian Civil Society Organizations (CSOs) who have adopted advocacy as a key strategy in tackling the challenges of gaps in policy, budgeting and administrative frameworks, with a view to advance Child and Family Health in Nigeria. The PACFaH Project focuses on four issue areas: Family Planning, Routine Immunization, Nutrition and Management of Child Killer Diseases-Pneumonia and Diarrhoea.


The PACFaH Project is implemented by Association for the Advancement of Family Planning (AAFP), Community Health Research Initiative (CHR), Civil Society Legislative Advocacy Centre (CISLAC), Civil Society Scaling up Nutrition in Nigeria (CS-SUNN), development Research and Projects Centre (dRPC), Federation of  Muslim Women Associations in Nigeria (FOMWAN), Health Reform Foundation of Nigeria (HERFON) and Pharmaceutical Society of Nigeria (PSN) in the following locations—Bauchi, FCT, Kaduna, Kano, Lagos, Nasarawa, Niger and Oyo.


The Heads of State and Government of the then Organization of African Unity (OAU) instituted in 1991 the Day of the African Child (DAC) celebration. June 16th of every year was set aside to highlight the challenges faced daily by the African Child. The 2016 theme is “Conflict and Crisis in Africa: Protecting all Children’s Rights”. Access to quality healthcare is a fundamental Right of the African Child. This Press Statement focuses on the sub-theme “Protecting the Children’s Rights: Fund Child and Family Health”.



FAMILY PLANNING:

Family Planning (FP) or Child spacing has been proven to be a very useful intervention in addressing Child and Maternal Mortality rate. According to the 2013 Nigeria Demographic Health Survey (NDHS 2013), Nigeria has a Maternal Mortality Rate (MMR) of 576/100,000 Live-Births, with one woman out of every 29 Nigerians facing a lifetime risk of death during Childbirth. Family Planning has been universally recognized as one of the key pillars and approach towards achieving safe Motherhood and survival of the Child directly and indirectly (it’s only a Healthy Mother that can PROVIDE & PROTECT THE CHILD). 



Due to its direct positive impacts on the Health of the Family and consequently the Economy of a Nation as a whole, meeting the unmet need for Family Planning can help Nigeria significantly reduce Maternal and Child Mortality.


Demographic dividend which is the accelerated economic growth that may result from a decline in the Country’s Mortality and Fertility and the subsequent change in the age structure of the population can be achieved through an effective Family Planning Program. Providing Family Planning or Child Spacing will avert at least Thirty-One Thousand (31,000) Maternal deaths, with over Seven Hundred Thousand (700,000) Mothers prevented from injuries or long-term complications due to Childbirth.


Hence, we urge Governments at all levels on:

·         Provision of appreciable access to Family Planning services through adequate budget provision, fulfilled Government’s commitment (London Summit) to Family Planning related issues;

·         Massive awareness creation on the appropriate compliance to the required Medical procedures in administering Family Planning services to secure individuals’ confidence and acceptance;

·         Prompt adoption and implementation of the National Blue Print on Family Planning (Scale-up Plan 2014–2018) and the Costed Implementation Plans to reflect the local context to promote effective implementation across the Country;

·         Sustained Free Family Planning Commodity Policy in all Public Health Facilities; and ensure uninterrupted supply of Consumables to make the Free Family Planning services really free, particularly to the poor Women in the Communities;

·         Adequate funds allocation for procurement of Family Planning Commodities and Consumables are released and used for that purpose;

·         Increase accountability and budgetary transparency for Family Planning Programs.



ROUTINE IMMUNIZATION: 

Immunization is the best buy in Public Health! Every Child has a right to access Life-Saving vaccines that would protect them against vaccine preventable diseases such as; Tuberculosis, Tetanus, Diphtheria, Meningitis, Pneumonia, Measles, Polio, etc. These Childhood Killer Diseases constitute a huge burden to our Society and is a major cause of deaths in Children below the age of five.  The Routine Immunization system in Nigeria is confronted with several challenges such as imminent shortage of funding for vaccines, inadequate budget for Routine Immunization, delay and piecemeal release of funds for Routine Immunization.

The recent announcement by the World Health Organisation (WHO) declaring Nigeria’s interruption of the long-time dreadful Polio endemic may soon resurge in the absence of provision of adequate finances by the Government to sustain intervention on Routine Immunization in the Country. We appreciate the Federal Government for the allocation of N12.6 Billion for immunization covering Polio campaign and immunization in the 2016 appropriated act. However, the Routine Immunization funds in the N12.6 billion are very minimal to cater for the 2016 vaccine procurement requirement. 


We hereby call on the Government:

·         For timely release of the Routine Immunization appropriated funds for 2016 and full implementation of the budget;

·         President Buhari to submit a supplementary budget to cater for the 2016 funding gap for Routine Immunization;

·         To encourage the active participation of CSOs and Media in the budget process;

·         To ensure adequate preparation for Leadership, commitment and capacity to identify and plan for sustainable sources of funding for Routine Immunization beyond 2021, as Nigeria begins transition from the Global Alliance Vaccines Initiative (GAVI) support.



NUTRITION:

                Adequate and proper Nutrition is another fundamental Right of the African Child. Unfortunately, African Children die daily due to preventable Malnutrition related illnesses. Malnutrition among Women and Children is a major challenge to Health and Human development of any Country.  Malnutrition is a condition that occurs when people consistently do not consume or absorb the right amounts and types of Food and Essential Nutrients.  Malnourished Children have an increased risk of disability and premature Death and are highly predisposed to infectious diseases. Nigeria has one of the highest burdens of Malnutrition Globally and ranks second globally with about Eleven Million stunted Children.


The  main  indicator  for malnutrition  is  stunting-when  Children  are  too short for  their  age.  Stunted Children have poor physical growth which is irreversible and associated with poor brain development and reduced School and work performance. Nationally the Nigeria Demographic and Health Survey (NDHS) Results of 2013, reported at the National level shows; prevalence of Stunting Thirty-Seven percent (37%), Underweight Twenty-Nine (29%), and Wasting Eighteen (18%) in Children under five years old. In Kaduna State, Stunting is at Fifty-Six point Six percent (56.6%), Underweight Fifty-Seven point Six percent (57.6%), and Wasting Forty-Two (42%) in Children under five years old. This means Kaduna State with Fifty-Six point Six percent (56.6%) Stunting has the third highest number of Stunted Children under-5 years of age in Nigeria after Kebbi with Sixty-One percent (61%) and Katsina and Jigawa with Fifty-Nine (59%) respectively.


The renewed international focus and donor commitment to address malnutrition has prompted the Nigerian Government to implement new policies and initiatives, culminating in the development of National Strategic Plan of Action for Nutrition (NSPAN) 2014 -2019 which sets out Nutrition-specific.


The Nigerian Government, through the Federal Ministry of Health (FMoH), has developed the Health Sector Component on National Food and Nutrition Policy: National Strategic Plan of Action for Nutrition (NSPAN) 2014 -2019. The document, if adopted and fully implemented, at the State and Local Government Area levels, will by 2019 reduce Stunting by Twenty percent (20%), reduce Childhood Wasting by Fifteen percent (15%) and increase Exclusive Breast Feeding in the first six months by Fifty percent (50%).


We urge Governments at the National and State levels to:

·         Adopt the National Strategic Plan of Action (NSPAN);

·         Implement the NSPAN with specific focus on Maternal and Child Nutrition component of the plan;

·         Create of specific budget line on Nutrition across relevant institutions, encourage Exclusive Breast Feeding, adoption and effective implementation of the costed NSPAN at all levels to combat endemic Malnutrition in the Country;

·         Increase funding for Maternal and Child Nutrition at the Ministries of Health and Agriculture;

·         Ensure prompt release and effective management of budgeted funds to promote accountability and transparency in Government spending on Nutrition.


MANAGEMENT OF CHILDHOOD KILLER DISEASES-PENUMONIA & DIARRHOEA:


The African Child is plagued with many Health challenges-most of which are preventable and treatable. The most recent Nigeria Demographic Health Survey (NDHS 2013) puts the National Annual Live-Birth figure as Seven Million, Twenty-Eight Thousand (7,028,000), of which Eight Hundred and Fifty-Four Thousand (854,000) die before their fifth (5th) birthday. The NDHS 2013 further indicates that for every One Thousand (1,000) live-birth, One Hundred and Twenty-Eight (128) of them will die before they mark their fifth (5th) Birthday (Under-5 Mortality Rate: 128 per thousand Live-Births). This translates to one in every eight Children in Nigeria dying before they reach five years of age.


Pneumonia and Diarrhoea account for 14% and 9% (respectively) of the U-5 Mortality rate amongst Nigerian children. Thus, in Nigeria no fewer than Four Hundred Thousand (400,000) children die annually from Pneumonia and Diarrhoea.


The major reason for these preventable deaths is POOR ACCESS TO HEALTHCARE, PARTICULARLY IN RURAL AREAS (which is a fundamental Right of the African Child).       This problem can be effectively addressed by ensuring the following:

·         Availability (up to the Community level) of recommended Essential Drugs (Amoxicillin Dispersible Tablet-Amoxicillin DT-and Zinc Low Osmolarity Oral Rehydration Salt-Zn-LO-ORS) for treating these Childhood Killer Diseases (Pneumonia and Diarrhoea);

·         Improved Healthcare seeking behaviour amongst Parents/Caregivers and appropriate referral to Healthcare Facilities;

As we mark the Day of the African Child today we urge the Government of Nigeria and relevant Stakeholders to place high premium on the adequate management of the aforementioned preventable and treatable Childhood Killers.


Our specific advocacy requests are:

·         The adoption and listing of Amoxicillin DT as the First Line Drug for the Management of Childhood Pneumonia in the National Standard Treatment Guidelines and the National Essential Medicines List;

·         States’ Ministry of Health to invest in and scale up the implementation of the National Guideline on Integrated Community Case Management (iCCM) of Childhood illness for the reduction of under-5 mortality, as directed by the 58th National Council of Health Meeting held in Sokoto in March 2016;

·         The implementation of the approved National Task Shifting/Task Sharing Policy at all levels as directed by the 58th National Council of Health Meeting held in Sokoto in March 2016;

·         Increase Public awareness and acceptance of the use of Zinc-LO-ORS Co-pack as the First Line Drug in the Management of Childhood Diarrhoea;

·         The creation of a  SPECIFIC BUDGET LINE for the procurement of these Essential Drugs (Amoxicillin DT and Zn-LO-ORS) that have been shown to reduce Pneumonia and Diarrhoea Deaths Globally and Nationally;

·         Timely release and judicious use of funds allocated for the procurement of these Essential Medicines as captured in the budget.





The PACFaH team is optimistic that the implementation of these advocacy requests will drastically reduce the unfavourable Maternal and Childhood Mortality from avoidable Maternal Deaths via increased uptake of Family Planning Commodities, Childhood Deaths due to Malnutrition, Vaccines preventable Diseases and Treatable Pneumonia and Diarrhoea in Nigeria.



Distinguished Gentlemen of the Press, we once again affirm our belief that Access to Quality Healthcare is a fundamental Right of the African Child.



The Healthier the Mother; the higher the chances of the Child survival and protection



Immunization is the Right of the African Child and the responsibility of us all; working together, we can close the Immunization gaps.



Let us end Malnutrition; proper and adequate Nutrition is a basic Right of the African Child.



This is the right time to end preventable and treatable Childhood Pneumonia and Diarrhoea Deaths; Let us join hands as Men and Women of Honour. #EndPneumonia #End Diarrhoea



Thank you for your attention.

Signed:

Chioma Kanu,

Program Manager,

Civil Society Legislative Advocacy Centre (CISLAC)




Dr. Hassana Adamu

Program Manager,

Health Reform Foundation of Nigeria (HERFON)




Diana E. Edema-Sillo,

Program Officer/Manager,

Community Health Research Initiative (CHR)




Sunday Okoronkwo,

Program Manager,

Civil Society Scaling up Nutrition in Nigeria (CS-SUNN)




David E. O. Akpotor,

Senior Program Officer,

Pharmaceutical Society of Nigeria (PSN)

Tuesday 7 June 2016

DECLARATION OF ACTION AFTER A 2-DAY TRAINING ON LEGISLATIVE ADVOCACY FOR ACCOUNTABILITY MEDIA IN CHILD AND FAMILY HEALTH ORGANISED BY CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) IN COLLABORATION WITH PARTNERSHIP FOR ADVOCACY IN CHILD AND FAMILY HEALTH (PACFaH) HELD AT NASARAWA GUEST HOUSE, KANO STATE ON 25TH AND 26TH MAY, 2016




Civil Society Legislative Advocacy Centre (CISLAC) in collaboration with Partnership for Advocacy in Child and Family Health (PACFaH) held a 2-Day training on Legislative Advocacy for Accountability Media in Child and Family Health. The training held at Nasarawa Guest House, Kano state on 25th and 26th May, 2016 was attended by about 25 accountability journalists. The training aimed at bringing selected and reputable journalists under one roof for training on appropriate skills and knowledge to effectively demand accountability in child and family health from the legislatures. After exhaustive deliberations on various thematic issues, we the participants:

Recognise that the United States donor agencies under Section 501(c)(3) of the Internal Revenue Code of 1986 are totally prohibited from lobby activities; and relevant media demanding accountability under the agencies’ projects and programmes must uphold and strictly adhere to the lobby-free provisions in their related coverage and reportage.

Also recognise that legislative advocacy is a deliberate process with demonstrated evidence to indirectly influence the legislators to support or pass a specific legislation; and lobby aims at directly influencing the legislators to support or pass a specific legislation.

Further recognise that government has the responsibility to commit necessary resources to health sector; and relevant stakeholders have the right to know how much and on what are the national/state resources expend on child and family health.

Express concern over preventable loopholes in the 2016 national budget, unchecked mismanagement of pubic treasury and persistent high cost of governance in the legislature despite inadequate budgetary allocation to child and family health.

Also express concern over poor political will towards full implementation of various national and international commitments on child and family health. 

Note that proactive effort by Government of Nigeria to ensure adequate understanding of the current budgetary system will command appropriate compliance to required standards in the budgetary preparation and implementation.

Also note that encouraged and well-funded independent media will prompt investigative journalism, evidence-based advocacy, comprehensive coverage and reportage on legislative accountability in child and family health.

Further note that inclusive and participatory media in material design and development will enhance ownership in data modification and utilisation to demand accountability in child and family health.

Affirm coalition building and proper networking among accountability journalists for appropriate update and data validation to inform accurate and credible reportage in child and family health.

Commit to embrace high level transparency, accountability, creativity and due diligent with verifiable evidence and strictly adhere to specific objective in coverage and reportage on child and family health through constant follow-up, period evaluation, investigative journalism, content sharing, and field study.

Also commit to effectively utilise existing legislation such Freedom of Information Act (FOI) in engaging all levels of governments for in-depth investigation, data validation to demand accountability in child and family health.

Will adopt constructive and proactive strategies to break related barriers and impending challenges confronting citizen participation, effective coverage and reportage in child and family health

Shall effectively engage the legislatures on their primary responsibilities—law-making, oversight, representation, constituency outreach, financial control, confirmation of appointment, and constitutional amendment—to demand accountability in child and family health

Averting the rising under-5 mortality in Nigeria



By Abubakar Jimoh

In Nigeria, pneumonia and diarrhoea remain major killers of children under 5 years, accounting for about 400,000 preventable deaths, annually.

While an estimated 6.7 million cases of childhood pneumonia are reported annually, Nigeria reportedly has the second largest burden of the disease after India which has about ten times Nigeria population. Pneumonia and diarrhoea are estimated to constitute 16% and 19% respectively of all causes of death in children below the age of 5.

In 2010, in a report titled Integrated Management of Childhood Illness by World Health Organization (WHO), diarrheal diseases were observed amongst the most frequent childhood illnesses and leading cause of preventable death, especially among children under five in developing countries with Nigeria included. According to WHO, “acute diarrheal diseases are one of the main problems affecting children in the world, reducing their well-being and creating considerable demand for health services.”

A study conducted by the United States National Center for Biotechnology Information (NCBI) in 2014 to develop context-specific strategies to improve care-seeking for childhood illness, Nigeria was identified as a high burden country with low rate of related treatment coverage, particularly in the grassroots.

The study concluded that while simple, inexpensive treatments are available for pneumonia and diarrhoea, yet too few children receive appropriate and timely care, particularly in high burden country like Nigeria and in the most deprived settings due to a range of interrelated factors—insufficient supply of life-saving commodities and trained health workers, poor geographic access to services, poor quality of care, as well as user-related financial and non-financial barriers.

In 2015, 5.9 million children around the world were projected would die before reaching their fifth birthday by WHO. 1 Of these 5.9 million deaths, pneumonia was responsible for 16% and diarrhea was responsible for 9%, making them two of the leading killers of children worldwide. Together, these diseases claimed the lives of nearly 1.5 million children under the age of five in a single year.

In another 2015 Progress Report on Pneumonia and Diarrhoea report published by the International Vaccine Access Center (IVAC) in collaboration with Johns Hopkins Bloomberg School of Public Health, it was revealed that lives of six children are lost with each passing minute. The report observes that although the number of child deaths in 2015 decreased compared to 2013 (6.4 million), the overall contribution of pneumonia and diarrhea to those deaths has remained rather steady (15-16% for pneumonia and 9% for diarrhea) over those two years.

In addition, the report bemoans pneumonia and diarrhea mortality in young children as they continue to be disproportionately concentrated in a few countries, year after year with 72% of the global burden of pneumonia and diarrhea child deaths occur in just 15 countries, even though they are home to only 55% of the world’s under-five population.

It is on the above premise that the Pharmaceutical Society of Nigeria (PSN) under the aegis of Partnership for Advocacy in Child and Family Health in Nigeria (PACFaH) notes that the global drive to halt unfavorable and preventable under-5 death statistics led to the inauguration of the United Nations Commission on Life-Saving Commodities (UNCoLSC) for Women and Children in 2010 with overall goal to increase access to essential life-saving commodities in 50 of the World's poorest and high burdened countries across the world.

As the UNCoLSC recommends effective guidelines (such as the adoption of Amoxicillin Dispersible Tablets and Zinc/Lo-ORS) as first line treatment of pneumonia and diarrhoea respectively to prevent the death of children under-5, PSN-PACFaH is seriously worried over impending challenges confronting effort to successfully combat the childhood killer diseases such as lack of budget line item by governments at all levels for the procurement and administration of life-saving commodities, poor political commitment and awareness.

Also, WHO in 2010, recommended 'Flexible Solid Oral Dosage' forms as the optimum formulation for Children's medicines administered orally, as they have proven effective and durable than liquids/paediatric suspensions, in addition to being less bulky to ship and store, especially in the grassroots.

It has become imperative for Nigerian Government to institutionalise the UNCoLSC recommendations especially the Pneumonia and Diarrhoea component that she co-chaired and signed in 2012.

According PSN-PACFaH, while preventive measures against pneumonia and Diarrhoea like vaccinations, exclusive breastfeeding, regular handwashing, vitamin A supplementation and proper nutrition are encouraged, however, these may not be sufficient to stop the rising under mortality in the country. Hence, full implementation of the UNCoLSC recommendations on Childhood Pneumonia and Diarrhoea has become imperative.  

Similarly, training and retraining programmes for the Front Line Health workers to acquire the current knowledge and skills to effectively manage childhood Pneumonia and Diarrhoea using Amoxicillin DT, and Zinc/ORS respectively are paramount to successfully win battle against the diseases.