1. HEALTH CARE DELIVERY AND RESEARCH IN NIGERIA: PERSISTENT CHALLENGES BY TOLU ODUGBEMI, MD, Ph.D, FRCPath, PNMC, FAS, NNOM, OON. Professor of Medical Microbiology & Parasitology, Vice-Chancellor, University of Lagos, LAGOS, NIGERIA. Fifth Kola Olafimihan Endowed Lecture, College of Health Sciences, University of Ilorin, Nigeria on: Thursday, December 11, 2008 at the New University Auditorium, Permanent Site, Ilorin, Kwara State

2. Health care service delivery to be efficient and effective depends on commitment and sincerity of man working with appropriate tools in a conducive environment or setting.

3. The number of training health institutions has increased considerably over the years. The curricula of training of health professionals vary from one institution to another. How effective?

4. Medical Training In Nigeria Teaching Hospitals Teaching Hospitals Specialists Hospitals Specialists Hospitals General Hospitals General Hospitals Regulatory and Examining bodies: Regulatory and Examining bodies: National Postgraduate Medical College{NPMCN} National Postgraduate Medical College{NPMCN} West African Postgraduate Medical College{WAPMC) West African Postgraduate Medical College{WAPMC)

5. Health research and development should be based on diagnoses of common diseases: Health research and development should be based on diagnoses of common diseases: Those that account for high rates of morbidity and mortality in the community with Those that account for high rates of morbidity and mortality in the community with Those with serious economic burden inflicted on the society. Those with serious economic burden inflicted on the society. For compiling research data, there should be For compiling research data, there should be well equipped and professionally trained staff in the health- care facilities, well equipped and professionally trained staff in the health- care facilities, laboratories and research institutes laboratories and research institutes

6. THE NATIONAL HEALTH POLICY AND STRATEGY The three tiers of health-care system were clearly spelt out as: Primary Health Care at Local Government Level Primary Health Care at Local Government Level Secondary Health Care at State Level. Secondary Health Care at State Level. Tertiary Health Care at National Level. Tertiary Health Care at National Level. Note that teaching hospitals are special tertiary health centres, which serve primarily as practical grounds for training health professionals in the College of Medicine.

7. HEALTH AND RESEARCH There is a need to undertake research at each level of our healthcare using appropriate technology.

8. TABLE 3: COMMON CAUSES OF VISITS TO HEALTH CARE FACILITIES (%) Infective and Parasitic diseases38.2% Respiratory diseases12.7% Diseases of nervous system and organ 9.9% Ill-defined conditions 9.2% Skin disease 8.4% Digestive system 4.7% Accidents 3.1% Muscles and skeletal diseases 2.9% Genitourinary diseases 2.7% Blood diseases – anaemia etc 2.5% Nutritional and metabolic diseases 1.8% Others 3.9%

9. Focal Areas of Research Basic or Biomedical Basic or Biomedical Clinical Clinical Operational Operational Pharmaceutical-Drug trials Pharmaceutical-Drug trials Immunological-Serological surveys Immunological-Serological surveys Laboratory –based Laboratory –based Field studies Field studies Applied Applied

10. Basic Aspects of Research Title: Identification of The Health Problem Title: Identification of The Health Problem Introduction and Literature Review Introduction and Literature Review Aims and Objectives Aims and Objectives Materials and Methods Materials and Methods Results Results Discussion Discussion References References Acknowledgements Acknowledgements

11. Role of Research Important and vital Important and vital Adds to knowledge Adds to knowledge Confirms old ideas Confirms old ideas Corrects old views Corrects old views Modifies accepted views Modifies accepted views Creates new concepts/hypotheses/theory Creates new concepts/hypotheses/theory

12. POLICY OBJECTIVES To promote research in basic, clinical, public health sciences at primary, secondary and tertiary health care levels in order to enhance quality of health amongst all Nigerians To promote research in basic, clinical, public health sciences at primary, secondary and tertiary health care levels in order to enhance quality of health amongst all Nigerians

13. Research Institutes Medical Research Institutes should be more effective. Medical Research Institutes in America and Europe serve as role models for other research centres. For example, the Centers for Disease Control and Prevention, at Atlanta Georgia, USA is in the forefront for health research, development and Diseases Control and prevention Medical Research Institutes should be more effective. Medical Research Institutes in America and Europe serve as role models for other research centres. For example, the Centers for Disease Control and Prevention, at Atlanta Georgia, USA is in the forefront for health research, development and Diseases Control and prevention

14. Reference laboratories should be established at each geographical zone of Nigeria. Reference laboratories should be established at each geographical zone of Nigeria. Health institutions should be well-equipped and properly staffed. Health institutions should be well-equipped and properly staffed. Active collaborative research works should be encouraged among the various institutions at local, national and international levels Active collaborative research works should be encouraged among the various institutions at local, national and international levels Research Institutes continued

15. Training Training Effective and good training of our students at postgraduate and undergraduate levels with up-dated curricula Community-Based Education and Service (COBES) programme (Ilorin Model) Community-Based Education and Service (COBES) programme (Ilorin Model) Re-training Re-training Trainers need to be retrained to prevent a ‘blind leading the blind’ situation. The introduction of Continuing Professional Education by some bodies is a most welcome- practice Funding Funding There should be adequate funding of our various diagnostic centres

16. Ethics Ethics Ethical practices should be enforced at all levels of our health-care diagnoses and research Information Information There should be adequate and proper means of dissemination of scientific findings through peer- reviewed journals, bulletins and presentations at scientific conferences

17. Monitoring, Standardization, Evaluation and Implementation Monitoring, Standardization, Evaluation and Implementation Personnel, equipment, supplies and laboratory infrastructures need to be regularly monitored to ensure quality control and quality assurance which should be adequately backed by internal and external assessments Policy and Guidelines Policy and Guidelines To ensure good research development, each laboratory must have guidelines and policies on all procedures, practices and safety

18. Akinkugbe, 1998 - “Through the present decade, Primary Health Care has been dramatized in a way as never before to the detriment of the other tiers of care. It is as if you have to pull the others down in order for PHC to thrive. Yet the successful prosecution of PHC not only depends on secondary (SHC) and Tertiary (THC), but on a vast and varied array of social infrastructure concomitants: Food, Shelter, the Environment, Education, Roads, Water, Communication and the Alleviation of Poverty”.

19. CONCLUSION Break the jinx! – individual Nigerians are nice but collectively in this nation, Nigeria remains “a developing country” Break the jinx! – individual Nigerians are nice but collectively in this nation, Nigeria remains “a developing country” There should be teamwork, commitment and sincere service to our nation in any one of our callings There should be teamwork, commitment and sincere service to our nation in any one of our callings