HEALTHY LIFESTYLE AND LIFE EXPECTANCY: HOW RESPONSIBLE ARE WE?

I am  Global Health Ambassador.

 

It is most shocking that life expectancy in Nigeria according to 2011 report is 52 years, it is the 17^th lowest in the world and i am really afraid because this is going to go even worse the way things are currently in Nigeria. I would rather think this report should have been of great concern to the Government of Nigeria mostly the Ministries of Health at both State and Federal levels; nothing has been significantly done to the best of my knowledge to improve on this statistics starting with health education and enlightenment on lifestyle improvement.

It would interest you to know that even our neighbouring countries like Ghana stands at 62 years while Niger Republic stands at 55 years life expectancy. We have countries like United States of America at 78 years, United Kingdom at 80 years while Switzerland and Hong Kong topping the list with 83 years life expectancy. 

Seeing some countries healthier than others is based on 3 predominant factors namely:

Access to and quality of healthcare (health equity and health equality)

Difference in lifestyle

Difference in environment

When we consider the environmental factor, you will realise no individual exists in isolation but within a certain environment which greatly frame our lifestyles on both short and long term. Our roads were built without walkways, estates are built without play grounds and most recently schools are approved without consideration for sports and recreational infrastructures but the question is how did we get here? I still remember my primary school and secondary school days where you have more than enough sports infrastructures in schools, we found these very useful and you never can imagined how much those things contributed to the school child’s overall development most importantly mental health. We had interschool competitions, principals’ cup football tournament, inter house sports competitions and many other activities which added fun to learning and created activities that aided the school child exercise. It is so sad, how it has turned out these days. Do you know children are beginning to be hypertensive even at school age? This is a new development that has become so disturbing in global health perspective. How can this trend be corrected? What needs to be done? Can we roll back the years? It is indeed really sad.

A child is supposed to clock 60 minutes exercise time daily, it may not be at a stretch but all his activities for the day put together. The society and environment we have found ourselves has not helped in any positive way, children are most times been restricted to just the parents’ apartment and sometimes the compound which ultimately takes away from them the opportunity to clock requisite exercise expected of them daily. They eat without the opportunity to burn out the energy and this leads to heavy storage of unutilised calories in their systems which they must pay for later in their life time. Even adults are the worse victims in the excess calories storage; we need to know that every individual is the driver of his or her own health conditions. 

We are living in an age where everything about and around us have become mechanised, we are a mechanised people living in a mechanised society in a mechanised age. No one walks anymore, there is huge vehicular movement on our roads, everyone wants to drive to even the nearest locations or shops, gone are those days where people walk to run errands or walk to visit friends. 

There was a recent study done in U.S.A and U.K which looks at categories of people who run their errands using their personal cars, chartered taxis, public transportation, bike/walk as means of movement. What was most shocking in this discovery is the percentage number of people amongst the group assessed in the category of walk/bike. 32.3% of the adult group assessed in U.K. walk or use bikes to run errands or sort out issues but shockingly only 6.3 % of the adult group assessed in the U.S. walk or use bikes to run errands or sort out issues. This may be a very useful contributor to the difference in life expectancy in both U.K and U.S.A as already highlighted above.

Let’s learn to walk again and go back to our bicycles, these are cultural lifestyles that are fast eroding. Our fathers used these means and they yielded good results for them, why has it become so alienated in many countries of the world and mostly the continent of Africa? Walk for life is a healthy lifestyle code, let’s adopt it.

Have you heard of a concept called “Energy Balance”? It is simply talking about the amount of energy intake over the amount of energy expenditure. If you took in all that energy, you should be ready to also expend it proportionately so you can live healthily. Ensure you take in as much calories as you have the capacity to expend, if we are not able to get this right then we run into health trouble.

In most families’ pantry and shopping list today, how many of fresh foods as fresh vegetables, fresh fish, fibre rich foods, green foods do we really find? Everyone has gone into the collective chase of canned food high in salt and this is not helping anyone’s health. Because of work and career demand, we have all become so dependent on “MRE” (Meals Ready to Eat) they are basically found in cans. You need to know these foods have preservatives, high salt content which has high potential to induce hypertension. Let’s do more of fresh foods, fruits, fish instead of red meat, low cholesterol oil, less of sugar, less of canned and preserved food, less of fries and the likes, we will just be on a new trip for better health. Non communicable diseases are becoming a huge global concern, diseases like cancer, hypertension, diabetes, high blood pressure, stoke and other cardiovascular diseases traceable to sudden deaths are very preventable when a healthy lifestyle is adopted.

I have realised, we cannot solely blame our inability to live a healthy life on other people or government policies, living a healthy life is a deliberate choice we must make as individuals and it takes a whole lot more than being disciplined to make it happen but most importantly knowing that you are responsible for what happens to you and that you can control things within your capacity as it has to do with your health.

A word, they say is enough for the wise, the ball is in your court. Living a healthy life is a human right, compromising this is not in your best interest. Do not add to the statistics, stay alive.

Thanks for taking out time to read this.

ehi@ohsm.com.ng

DISASTER PREPAREDNESS AND SAFETY CULTURE AS EXHIBITED BY CUBA. A CLUE FOR GOVERNMENTS OF OTHER NATIONS

My dear readers, i came across this article written by Reihana Mohideen, a socialist feminist from Manila Philippines, i had to read it over and over again to my amazement. I became caught up in a web of emotion when i read about President Fidel Castro going to give assistance and rescue support in an area that has the highest risk when Cuba was hit by a disaster. No one could have asked for anything more.

We have always sang this in our blog articles that nothing happens outside leadership will and commitment, we cannot categorically say Cuba is a high income earning country but there is a political will to secure the lives of its population from those natural disasters peculiar to their geographical locations. Imagine being hit between 1996 and 2002 with 6 major hurricanes but see the minimal number of people lost to those 6 incidences. Their school curriculum has been fully laced with emergency preparedness and response contents, trainings are made available to everyone annually.

Maybe we just juxtapose this with the Philippines and Haiti scenarios where corruption and mental slavery have taken priority seat over the safety of the people and in some cases where standard has become an issue not to be discussed or evaluated. It rends my heart when mass of people are allowed to die through avoidable deaths when it could have been prevented if we only tried. The last disaster that hit Japan has been the biggest of it all but it did not catch the Japanese Government napping, preparations were in place and people knew what to do, teams were deployed immediately to the regions affected and lots were salvaged and lives were saved. We do not make preparations in the face of disaster; it is planned and prepared for in advance. People can only respond to the capacity they have been trained, we need to build and develop disaster management capacity to give some sort of mitigation which always goes a long way. Disaster naturally overwhelms everyone; the need to prepare is a huge succour.

The “Cuban Way” is the way and i challenge everyone to look into what his country has put in place from political will to attitude, training and the likes. I think we need to talk to our governments and leaders on the need to look inward; we cannot afford to continue this way. Cuba has proved to us that ability to prepare is not a function of funds but a deliberate effort to identify what you are faced with and make provisions for its mitigation. We will praise New Zealand for the standard they have set in quality building structure and codes, this is worth emulating.

Please read the article below and make your opinion felt. Remember Salus Populi Suprema Lex (The Safety of the People is the Supreme Law).

September 8, 2010 -- Comparisons must be made between the impact of the September 5 earthquake on Christchurch, New Zealand, and the quake that hit Haiti in January. The nature of a global system that maintains these inequalities should be exposed over and over again. In Haiti – with a population of around 9 million – some 250,000 people died in the earthquake and (according to government figures) 200,000 were injured and 1 million were made homeless. Some eight months later disaster still grips peoples’ lives. Fortunately, but in a staggering contrast, no lives were lost in New Zealand, although the earthquake was of a similar -- but slightly more powerful --- magnitude (7 on the Richter scale).

New Zealand’s building codes set a world standard in seismic building regulations and are incorporated into the building codes of several countries, including the Caribbean Uniform Building Code. Haiti, on the other hand, had no known building regulations. According to a report provided to the Global Task Force on Building Codes by a member of a disaster risk management team that visited Haiti prior to the earthquake in 2009, Haiti reportedly has some building regulations, but they were not focused on building safety and were rarely implemented. Haitian civil engineers and architects said that any codes used for professionally designed and constructed private buildings would not be Haitian – but would depend on where that person studied (USA being most common). Donor-funded buildings are usually built to a standard stipulated by the donor or by the professional in charge. The State University’s engineering curriculum did not have any substantive elements on building codes.

Philippines

The Philippines is one of the countries’ most vulnerable to earthquakes and studies have found that the country’s school children are especially vulnerable due to substandard building construction. Tens of thousands of people could die, in Manila alone, from an earthquake of the magnitude that hit Haiti and New Zealand. The building industry is riddled with corruption, undermining the implementation of building industry safety standards and regulations. The urban poor, who are a significant proportion of the urban population, live in hovel-like structures that are assembled with flimsy pieces of cardboard, wood and discarded roofing materials, easily washed away by rains and typhoons. Typhoon Ondoy, which hit the country in October 2009, killing thousands of people and displacing tens of thousands, gives us a terrifying preview of what an earthquake could unleash.

But the problems faced by those of us living in Third World countries in coping with disasters goes beyond the inadequacy of building regulations. The basic problem is poverty. A glance at the UN’s ranking of countries based on its Human Development Index (a measurement of education, life expectancy and income) is an indicator of the problem. Haiti’s ranking is 149 to New Zealand’s ranking of 20 (out of 182 countries). Philippines ranking is 105. The massive numbers of lives lost in disasters is a direct result of poverty. The poor in the Third World are more vulnerable, including to climate change-induced disasters, than those in the industrialised countries.

Cuba

However, even a poor country can take effective measures to mitigate the loss of lives and injuries if there is political will in government to prioritise protecting the lives of its people. If New Zealand sets the world standard with its seismically safe buildings, then Cuba sets the world standard on how a poor country can save lives during disasters. And the Cuban example has been acknowledged and praised even by those not partial to the Cuban Revolution, such as the United Nations, which identifies Cuba as a case study in disaster risk management. Between 1996 and 2002, six major hurricanes hit Cuba, killing 16 people out of the total 665 deaths in the affected countries. Hurricane Charlie killed four people in Cuba and 30 people in Florida. When Hurricane Ivan threatened Cuba, the country evacuated 1.9 million people, 17% of the population, over 15 days. All shelters were staffed with nurses, and doctors were sent to the high-risk areas. Then-president Fidel Castro went to the highest-risk area to assist the effort. No one was seriously injured or killed as a result of the hurricane.

According to the International Secretariat for Disaster Reduction (ISDR), the UN body that focuses on disaster reduction, “the Cuban way could easily be applied to other countries with similar economic conditions and even in countries with greater resources that do not manage to protect their population as well as Cuba does”. The ISDR says that Cuba is an example that the vulnerability of people can effectively be reduced with low-cost measures and strong determination. According to the ISDR the Cuban authorities are determined to implement disaster reduction policies in Cuba. “It is part of their development planning and their culture, which play a key role in saving lives and livelihoods. This illustrates the importance of a strong political will … Leaders of countries around the world have at their disposal the knowledge needed to reduce risk and vulnerability to hazards. Even poor countries are not entirely without options to mitigate or prevent the consequences of hazards. What is often lacking are concrete programs of action and the political will to implement policies and measures."

This Cuban “political will”, however, does not emanate from particular individuals or even governments. The “Cuban way” is the logic of a society – an entire social, economic and cultural system – that places human beings and their needs as its central and fundamental priority. Cuba’s economy and society are based on socialist principles prioritising people before imperialist profits, resulting in the highest levels of human solidarity and culture. Haiti, in contrast to Cuba, tragically and despite its heroic and historic struggles against colonial slavery, has been exploited for decades by imperialism, which has intervened in its political affairs with impunity, supporting coups and organising military interventions to overthrow pro-people governments, a history that we in the Philippines are familiar with as a result of our own semi-colonial relationship with and dependence on the United States.

The Cuban government is unique in that it has paid an equal amount of attention to the structural and physical aspects of disaster preparedness, but has also created a “culture of safety” through successful education and awareness campaigns. The ISDR points to education as one of the main reasons for the low level of hurricane mortality rate in Cuba compared to its neighbours. Disaster preparedness, prevention and response are part of the general education curriculum. People in schools, universities and workplaces are continuously informed and trained to cope with natural hazards. From their early age, all Cubans are taught how to behave as hurricanes approach the island. They also have, every year, a two-day training session in risk reduction for hurricanes, complete with simulation exercises and concrete preparation actions. This facilitates the mobilisation of their communities at the local level when a hurricane hits Cuba. Cuba’s entire adult population is literate and therefore can access educational materials about disasters. The Cuban Red Cross, which provides teaching material, is reinforced by training courses and disaster drills for parents in the workplace, as well as by radio and television broadcasts.

There is an adequate road system in the country that facilitates speedy evacuation and building codes are enforced, which reduce the element of highly vulnerable substandard construction. Approximately 95 per cent of the households in the country have electricity and therefore can access information about disasters through radio and television. Most importantly, the Cuban population is mobilised through a range of social, professional and political organisations in the country that provide structures that can quickly mobilise the entire population in disaster.

All these features of Cuba's disaster management program are direct results of the gains of the Cuban Revolution, which has created one of the most socially conscious, educated and politically organised and mobilised people in the world. We, in the Philippines, have much to learn from the “Cuban way”.

[Reihana Mohideen is from the international desk of the Partido Lakas ng Masa (Power of the Labouring Masses Party. This article first appeared at Reihana Mohideen's website, Socialist Feminist.]

DISASTER MANAGEMENT OVERVIEW: FLOOD RISK

We have observed incident trends of late amongst localities and even countries; it has become a very disturbing issue the spate of flood risk exposure amongst vulnerable settlements and communities. This disturbing flood disaster has again been identified as one of the fallouts of global climate change which we have all been collectively responsible for. This trend would continue and even go worse if we do not see the care of environment as our individual and collective responsibility, the need to change our attitude towards the mother earth is of utmost concern if we really desire to put a check or control to these natural disasters that we are left to contend with.  

Many communities in Nigeria suffered colossal loss 2012 owing to the unexpected flood disaster that ravaged some parts of Nigeria. This could have been avoided or mitigated if we clearly identified and recognise the peculiarity of risk we are exposed to base on our geographical positioning. It does not really matter how you pay deaf ears to the sound and presence of those risks, one thing that is clear is that they will surely occur whether you plan for them or not. Planning will help mitigate the effects and facilitate quick and better recovery.

The best and most important approaches to disaster management are Planning and Right Attitude. These two factors are key components in effective disaster management. Planning talks about the conscious preparedness you have put in place to mitigate disaster should they occur, this spans from strong framework policies driven by government, people engagement and participation, funding, partnerships, education and training, Health, provision of relief camp and materials etc. These and many more constitute part of the planning processes and must be sequentially designed, tested, evaluated and reviewed routinely.

Flood as it concerns us in the context of this presentation has been defined as an overflowing of a large amount of water beyond its normal confines or boundaries, especially over what is normally dry land.

Flooding is said to occur when land not normally covered by water becomes covered by water or when heavy rainfall overwhelms the drainage capacity of the local area.

Flood disaster always has a huge impact on:

·         People

·         Property

·         Economy

·         Overall environment

 

Flood risk is mostly caused by the effect of climate change such as severe rainfall and rising sea levels which normally increases the risk of already affected areas and put other areas that may not have been flooded in the past at risk also. We need to me more vigilant than we were in the past as a way of adapting to the reality of climate change in ensuring the risk of future flooding is integrated into the planning through spatial planning processes at State, Regional and Local levels.

Flooding seem to be catching up with most emerging metropolis and mega cities like Lagos, Mexico, New York and the likes. This is due to the massive economic development projects to meet the socio-economic need being embarked upon without due hydrological and environmental consideration, this most times leads to destructive incidences even in regions that used to be considered safe.

LAGOS OVERVIEW

Lagos is a coastal city bound to experience coastal flooding caused by higher sea levels than normal, largely as a result of storm surges, resulting from the sea overflowing into the land. There is also the issue of inland flooding which is caused by intense or prolonged rainfall which Lagos has of late been characterised with.

Coastal flood is greatly influenced by 3 factors namely:

·         High tide level

·         Storm surges caused by high winds

·         Wave action which is dependent on wind speed and direction, local topography and exposure

 

Flooding may also arise from failure of infrastructures designed to store or carry water or to protect an area against flooding e.g. the breach of a dam, leaking canal or a burst water main, breach of a flood defence, failure of a flap valve or pumping station or blockage of a pipe or culvert. The impact of such sudden flood unset can be severe and must be assessed in planning.

Interestingly, Lagos, apart from being the industrial and commercial hub of Nigeria and the West African sub-regions, it is also the biggest city in West Africa, and it is projected to be one of the world’s five largest cities by 2015 (Federal Ministry of Education and Research, 2004). It has a very diverse and fast-growing population, thus normal pressures of urbanization and forces of modern development has resulted in the city expanding to nearby suburbs like Lagos NE, which politically covers Lagos and Ogun states of Nigeria.

Unfortunately, the encroachment and development of the suburb best quality farmland, large scale massive deforestation and loss of surface vegetation are being carried out in an unplanned mode. Even the  encroachment of urban facilities on Ogun River and its tributary floodplain (waterways) and unprecedented land reclamation without strict adherence to land use and natural waterways planning, is also evident. With all these indiscriminate occurrences, we wonder if the Land Use Act is still an effective Act to implement or does it need an upscale in form of review or some people are not just able to enforce the content of the document. If we allow this spate to continue, the disaster that we are currently faced with will be nothing compared to what is to come. Urgent behavioural change has to be pursued and achieved to enable us have a sustainable environment, not void of risk but environment where risks are under considerable control. Flood is therefore being aggravated through numerous physical and social alteration of the natural environment, which has increased the impervious surfaces (Oyebande, 1990), and occupancy of unsafe land and hazard prone region, without an appreciable harmonizing scheme between nature and the developmental activities. This has created a lot of social and economic cost on the environment and the citizenry. The need to resolve the severe flood incidence within parts of Lagos NE, call for proper estimation and mapping of floodable areas at acceptable risk level, in order to provide essential tools needed towards attaining an integrated flood pre-disaster and lead-time scheme within the region.

Having this background in mind, we need to assess the levels of plans and preparedness measures we have put in place to ensure the potential impact of flood at the really of hazard is rightly minimised. The approach to this is to identify the vulnerable groups, their different levels of exposure and what we all stand to lose. Flooding has been known to induce the following:

•       Physical injuries, illness and loss of lives

•       Deep, fast flowing or rapidly rising flood waters can be particularly dangerous. Even shallow water flowing at 12 metres per second (m/sec) can knock children and many adults off their feet.

•       Some of these impacts may be immediate such as drowning or physical injury due to being swept away by flood.

•       Flood water contaminated by sewage or other pollutants such as chemicals is particularly going to cause illness either directly as a result of contact with the polluted flood water or indirectly as a result of sediments left behind.

•       The mud ways also causes physical hazards via slips and falls.

•       Some of such health diseases include nasal congestion, respiratory infection, diarrhea, flu etc.

Flood also has impactful damage on properties in diverse ways as highlighted below:

•       Flood water is likely to damage internal finishes, contents and electrical fittings, and other services and possibly cause structural damage.

•       Re-occupation of a property damaged by flood could take a long term and huge investment has to be made for cleaning and restructuring.

•       Vehicles and equipment are not spared also in this impact.

•       Sea water may cause additional damage as corrosion.

Public infrastructures are not left out in the potential damage and they come in the forms below:

•       Flooding impact on infrastructures such as transport and utilities as electrical and water supply can have significant detrimental impact on local and regional economies.

•       Flooding of primary roads can deny access beyond those areas directly affected for the duration of the flood event, as well as causing damage to the affected roads, people cannot go to work, children cannot go to school etc.

•       Flooding of water distribution infrastructures such as pumping station or electricity substation can result in loss of water or power supply for large areas.

•       This can magnify the impact of flooding well beyond the immediate community.

•       The long closure of businesses can lead to job losses and other economic impacts.

Having taken our time to carefully look at the effect of flood disaster and how it impacts on human beings and our entire environment, i would rather think it should be given a very significant place in day to day running of government if indeed the government owns the responsibility to secure lives and properties of the citizenry. Budget and requisite funding should be made available and rightfully deployed and appropriated in the interest of the people and the environment at large. There is the need to have a legal document on National, State, Regional and local disaster management which must be made available or made accessible to everyone so we all know what our roles are when it comes to disaster management. Most times, what we see or hear is mere political boastful statement that amounts to nothing at the end of the day.

It might interest you to know that the geographical land mass affected by the disaster that struck Haiti was far less than the geographical land mass affected by the disaster that struck Chile and even Japan. But Haiti suffered more loss compared to Chile and Japan, this is a clear indication of the economics of disaster preparedness plan with high commitment of time and resources.

Like we all may have known, disaster management comes in 4 circles namely:

Preparedness: Readiness activities effected to minimise loss or damage

Response: What we do when disaster strikes

Recovery: When we start to ask questions on what we have learnt and what we can do to make the next if any, better.

Mitigation: All the things we can do to make us survive disaster

These all involve a thorough risk assessment which must cover plans as:

Communication: This has to do with information ins and outs. In time of disaster people need to know what to do, the safe places to evacuate to if they have to, the roads that are open and safe to drive through, where to get treatment or food during such situation. The designated authorities most times have what is referred to as incident command system that has a number of structures which also covers communication. You all need to have a family or personal preparedness plan and a jump bag which must include a small battery powered transistor radio to get information and instructions on development outside your immediate environment.

Security: In most disaster situation the most important concern is not to add to the burden of work already getting everyone overwhelmed, whether you are a responder or not you also need to get back home safely at the end of the day hence the need for security plan as an important consideration.  

Authority: In situation as disaster, the need to have someone who has been appointed to take charge is important else everyone does what he or she likes and complicates issues for everyone. We need to plan for an incident command system and appoint someone who have been trained and experienced to take charge; he is the leader of the entire disaster management structure.

Disaster management comes with basic need as:

·         Water

·         Food

·         Shelter

·         First Aid

·         Environmental concerns

·         Tools

·         Comfort and more

 

We also need to know in time of disaster, we also need to help when we are in a better state to do that. We also need to know what the “old normal life” and the “new normal life” means and our ability to adapt to the new normal life psychologically will help us a great deal. You may have owned and lived in a very comfortable apartment with Jacuzzi but you may have to sleep on a debris hut with minimal cold shield during disaster. You need to condition your mind to be able to survive this difficult period and you also need to make personal survival plan for basic needs that will last you for a minimum of 3 to 7 days. Meals Ready to Eat (MRE) are mostly what you will have to depend upon (mostly dry and canned food), you may have food to cook and there is no water, no gas or stove or even cooking pot. But with dry or canned foods, they do not perish easily and they are as good as food on-the-go.

Have you ever asked what could be done when you run out of potable water? In disaster situation, you may need to create potable water by treating water with drops of chlorine bleach, iodine tablets, steri pen and other filtration system. Boiling is an option but it is a luxury in a disaster situation, you can also use other means of water filtration systems. All these mentioned above is to kill the germs (bacteria and virus) so you do not get sick of enteritis but this cannot take care of the particulates but the filtration system does. You need an average of 1 gallon of water per person per day, so you need about 7 gallons of water to survive for 7 days. This is important so you do not suffer dehydration that could make you vulnerable to illness.

To be continued....................................

Some of this information shared is from the work of Olusegun Adeaga of Department of Geography University of Lagos, other personal research and teaching from Dr. Michael Beach who is my course instructor in my on-going course on Disaster Management at University of Pittsburgh, Pennsylvania USA. I should be done in 3 weeks when i will have the time to share a number of new things with you.

Thanks for always following my blog and the very good comments left behind are really encouraging. Keep them coming.

ehi@ohsm.com.ng

INTERNATIONAL MEDICAL ASSISTANCE AND LINGERING CHALLENGES

International Medical Assistance is a concept that was designed to ensure that health policy holders of any international health insurance companies are able to use their policy cards across the world with little or no difficulties. This was the idea and thinking of health insurance providers that gave room to International medical assistance program.

Though the concept has strived and performed optimally well in some countries of the world but difficulties are still being faced in proper administration, non availability of standard healthcare facilities, poor access to very fast medicare at the time of critical need, these and many more are the issues still hindering the smooth and efficient administration of international medical assistance services across the world.  

There is an urgent need to critically review processes in ensuring enrolees get good value for their money and the healthcare facilities are also rightly motivated and incentivised through timely clearance of all Guaranty of Payments (GOP) if in use and in some cases have serviceable credit lines. At the moment, the risk is currently being shifted to the enrolees who most times are not granted access to medicare either because their health insurers are not known in that part of the world they find themselves in and even in some cases they have no enough funds with them to pay off the medical bills which will be duly refunded anyway. When such cases occur, one begins to wonder if it would not have been better to have your funds to yourself and be self accountable for all health challenges and eventual outcomes within a fiscal year.

My questions are:

·         Are there ways to do these better than we are currently doing?

·         Can we collate all questions and challenges reported to a round table and identify better ways of improving on the existing services and processes?

·         Can we fully take up the risk, instead of virtually sharing it with the policy holders?

·         Are there international trade barriers that currently impede the smooth administration of international medical assistance? Can they be identified and reviewed?

·         The state it is now, can our products really win and sustain subscribers confidence? If no, then the time for review has come.

·         Are existing frauds within all levels of implementation stages also factors to be considered? If yes, can we profile the countries of high prevalence and work out ways round it?

·         Is there the urgent need to tag-on with the local health insurance companies in ensuring a face is attached to the management of subscribers in such country of treatment?

I have become rather worried over these issues of late mostly the ones i have seen in Lagos Nigeria under the international medical assistance platform. Maybe we should even define health insurance in the right context; it could just be the missing clue to fix this whole confusion.

Health insurance has been defined as the insurance against the risk of incurring medical expenses among individuals. Or

The insurance that compensates the insured for the expenses or loss incurred for medical reasons, as through illness or hospitalization.

The statement common to the two definitions are “incurring medical expenses” and if health insurance must act in line with this definition, it means there must be that capacity and capability to absorb or manage the health risks of the subscribers within the period of the validity of their health policy. We need more people into this pool and the only way to make this happen is to ensure a high level of trust and confidence exists between the insured, the insurer and the treating facility. The interface must be strong, cordial and mutually of measurable benefit to all parties concerned.

There are a whole lot of distrust which currently exist amongst this circle of stakeholders which have greatly imparted negatively business relationships and quality of care delivery. We understand the huge fraudulent practices and gross dishonesty on the part of the subscribers also which has a huge cost effect on the finances of the international medical assistance company. Most of these false policy claims arise from falsification of medical bills, falsification of admission that never existed, claims of known costly treatment that were never done. There could not have been such claims if there was no connivance with a health facility or a treating Doctor that issued both the false medical report and the acclaimed medical bill which the policy holders always claim they have paid for with valid receipts to support such claims. This has created a level of distrust with the relationship chain; investigations and excessive scrutiny are now in place to verify claims even when they are genuine. Is this practice what we can do away with? Yes, we can.

We do not need to play in every market, let us play in markets where we can have a level of control for our products or where we can have responsible persons or organisations duly representing our interest in effectively managing our subscribers. The International Medical Assistance companies should defractionalise and close up the market with strong capacity building and development which makes them form a strong mass through a collection of several insurers having a cover under one umbrella and trading in that name in countries where they have no comparative advantage. This we see already happening among the International Assistance Group (IAG), other smaller companies registered under them use their names in countries where they have strong controls. This is all to the benefit of the subscriber.

We have had to investigate a number of cases, case-manage so many other cases and even sometimes we had to place a local Guaranty of Payments (GOPs) in place on personal recognition for the sake of the subscribing patients who needs medicare at such times. We still feel these are not all enough, there is the need to have a face to your international medical assistance policy having an in-country representative who will at all times be available to help sort you out. When this happens, we can have international health policies and travel to Ukraine, India, Bangladesh, Morocco, Australia, China, Venezuela, Sweden and of course Nigeria without having any difficulty in accessing quality medical care based on trust, equity and fair play on the part of all stakeholders within the wheels of best global practices.

There is also the need to understand infrastructural gap which still exist in most countries and there are times mails are sent about a patient sent to healthcare providers and they at the hospitals at that moment do not have a functional internet services, these and many more creates a number of breeches in trying to run a smooth and hitch-free processes.

One of the things our company has done of late is to be able to position properly for the International Medical Assistance companies in ensuring we cater for all requests sent to us seamlessly by closely interfacing properly with all notable hospitals across the country and riding on the wings of such relationships to ensure nothing is left to chance.

We have become very involved through our Medical team in:

·         Case management

·         Bills verification and negotiation

·         Admissions confirmation

·         Treatment review and confirmation

·         Case bookings

·         GOP placements

·         Third party hospitals management

·         Local and international medical evacuations

These have greatly become very crucial units within our growing SBUs. We will keep innovating changes and ensuring what ought to be done are rightly done to create requisite value for not just the patient alone but the healthcare facilities and ultimately the International Medical Assistance community.

We just wanted to share our market experience, opportunities and the daunting challenges. Kindly read through and leave a comment.

ehi@ohsm.com.ng