‘Why persons with HIV should pay for treatment’
Prof. Innocent Ujah is the Director General of the Nigerian Institute for Medical Research (NIMR) Yaba, Lagos. Ujah in an exclusive interview with The Guardian gave reasons why persons living with HIV/AIDS in Nigeria (PLWHAN) should now pay some amount of money for requisite medical tests and treatment. The consultant gynaecologist also said that the results of national study on growing resistance of the virus to antiretroviral drugs (ARVs) for the treatment of Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS); malaria parasite to World Health Organisation (WHO)-approved Artemisinin-based Combination Therapy (ACT) drugs; and the prevalence study for Human Papilloma Virus (HPV) that causes cervical cancer should be out in 2016. Ujah said the major challenge facing the institute and many other research bodies in the country is poor funding even as he throws more light on why some workers are protesting against some of his decisions to move the institute forward, among other things. CHUKWUMA MUANYA, Assistant Editor (Head Insight Team, Science & Technology) writes.
• Results of study on resistance to HIV and malaria
drugs, cervical cancer prevalence expected in 2016
• Poor funding limits research activities in science-based
institutes across Nigeria
I have come to notice through investigation that all the institutes across Nigeria are highly under funded, and even when they get money from government it is only sufficient to pay salaries and to do basic maintenance that there is no money left to do research, and this has forced some to go into Public Private Partnerships (PPPs) to survive. What do you think can be done to remedy this issue of underfunding?
Obviously, funding for health research and any form of research is capital intensive. Firstly, the policy makers and political leaders must have a political will to fund research and embark on research. This year, apart from paying salaries, the only amount of money that came for capital was N25 million meanwhile we have the United States Centers for Disease Control and Prevention (CDC) grant of $200 million (N51.6 billion). N25 million is nothing to compare where we have six generators that have to constantly function for 24 hours. The little fund we have is to ensure that the little we have is not wasted and the result we will get will be reliable.
The issue of funding is something that should be talked about. All the research institute must come together and let the government know that for the country to develop we must have sufficient funding and of course ensure that it is properly managed, bearing in mind that there is misappropriation, and to ensure that it is properly managed because the problem of fund is very important and we have to check it out.
In the light of government’s complains about the unavailability of money, what is your advise to them and what do you think can be done to get this fund?
To that, I would say that there are several foundations in the country and we have great Nigerians that are very rich but it is unfortunate that they do not see the rationale for investing in health research. I believe philanthropists can help out. We have had cases where high profile persons loose their loved ones to one disease or the other so the question is why will they not have a foundation to research further into the disease and by doing that we come out with results.
A year ago, one of the breweries commissioned NIMR to do research on alcohol use in pregnancy because they want to be sure that alcohol be properly and effectively used during pregnancy, so that it does not affect the baby. These are the things we would have apart from talking about government funding.
We would have to encourage staff to write for grants but the problem is not writing for grants but knowing that it does not solve national problem because the said grant might be specifically to solve other people’s problem. But in a case where we are talking about national prevalence study on cancer of the cervix or Human Papilloma Virus, this is specific for our people because it is our own need so we find out that it tailors to the need of our nation. That is why they said we should carry out research for national development not for international development but it can contribute to international development.
In essence what I think we should be doing is first of all to continue advocating for effective funding for research and health research in particular, secondly there is need to bring the philanthropists to realize that research and development drive the economy because when are talking about people going out of the country for medical tourism and the likes. If the things they go for, following research can be done even without the equipment because they can be brought as service and research equipment. For instance, our human virology laboratory not just provides us the opportunity of carrying out research but also the opportunity of services. For instance those living with HIV have to get their money for treatment monitored and also money for CD4 count (a marker for the immune system) monitored, their hemoglobin and the rest monitored regularly. So in essence the laboratory can be used not only for research but also for services.
Our feeling is that the political leadership be able to appreciate research for national development and it is only when we realize that something is important that we can invest in it.
People living with HIV/AIDS are complaining of introduction of fees for their treatment that was hitherto free. Why?
It is unfortunate because I had written a memo to the immediate past Minister of Health, Prof. Onyebuchi Chukwu, about the issue of services to people living with HIV/AIDS. During the United States President Emergency Preparedness Fund for AIDS Relief (PEPFAR) programme, there was a lot of funding for HIV cases but unfortunately the programme is winding down and the question is do we continue to run the clinic for those living with the virus or we leave them to die? Because it is not a simple decision that was why we wrote a memo to the minister on the two options we had which were either to have a minimal user charge or to continue with the clinic or close it down.
As a senior medical doctor, it will not be appropriate in my opinion to close down the clinic. So what we did was that those who were project staff were not laid off, we had to first of all reabsorb them into the institute because they are providing services to a lot of people. If we do away with them it means that the clinic was going to close down which will bring additional burden of paying salary for these individuals because they will now be considered as NIMR staff.
Secondly, if we have minimal user charge and keep the clinic going, it is for the benefit of our people and that is what has happened. It is not anything compared to the investigation for cancer. We now know that following the development; HIV/AIDS is a chronic disease just like diabetes and cancers. These diseases cannot be managed free, they are to be paid for and whatever money they pay is to help them.
I would go any length within the law to help these individuals survive rather than close the clinic and have many of them suffer. We have cumulative number of over 23,000 persons with HIV and I can tell you that our clinic has done so well that the mother to child transmission rate is less than one percent. As a matter of fact it is 0.1 percent and that is as against 30 per cent that were not monitored or treated. This to me is an achievement as others can now have their babies with little or no fear of their babies having the infection. We are reducing the new transmission rate and I believe that what we need from people living with HIV/AIDS is love and support, because if that is not done, the clinic will be closed down and once that happens many of them will die.
But we need a voice to speak for these people, what do you have to say to this?
The National Agency for the Control of AIDS (NACA) once had a national conference on HIV/AIDS and the topic was ownership, where we had to take ownership in addition to the provisions of pro- funding. This is in line with what NACA is saying that the government of Nigeria needs to increase the funding for HIV/AIDS treatment, prevention and control. We have also advocated for extension of this help to those living with cancer and other chronic disease like hypertension and diabetes. But the fact remains that the burden is high for the government alone to bear its running, which leave us with the options of seeking help from other sources.
In my opinion, these individuals should pay minimal charges to help them live than say no charges at all and have the clinic closed down.
There is another issue of malaria drug resistance. Some Nigerians complain that the drugs provided are substandard while others complain of having their malaria untreatable. What do you have to say about this?
We have a very sound research group here and we are doing well to track the resistance to malaria and other illness. The issue of standardization is on the high side and even was discussed in the national assembly recently. If one is using substandard drugs on any treatment, there is no doubt that these organisms will change their colt and get used to the drugs and that makes the drugs ineffective.
Another thing to do is for Nigerians to have a change of mind and change of heart to be able to provide quality drugs, because the importation of substandard drugs obviously contribute to the resistance of malaria.
I sometimes pity the National Agency for Food Drug Administration and Control (NAFDAC) because the country is large and controlling it is a problem. But I must commend them and appreciate the effort of the NAFDAC in fight for a healthy country; individuals should have a change of heart.
How about the issue of workers unrest in NIMR? What do you think is the cause for the lack harmony in line with their recent agitations?
I must say that agitation from workers is everywhere around the world and it is good news to know that I have been here for close to six years and something of that nature has not come from me. The issue of agitation is what people sometimes feel they can just do. For instance, we had an issue of accusation for non-payment of promotion arrears and when we heard this we told them to find out from the accountant general.
These things are verifiable, we are researchers and we try as much as we can, not to work on speculations. If there is need for information on what is happening in the institute, those fueling the accusations should ask questions from the right source, of course there is freedom of information act but we find out that there are still people that are disgruntled, who think that they should bring down the institute. We have been talking to them but because of this mentality of change people think they can wake up one morning and start to initiate ideas and suggestions. We advise them to always think of what they want to say before coming out to say them…
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