- Email: [email protected]
Institutional corruption, health-sector reforms, and health status in Nigeria
Correspondence
We declare no competing interests.
*Joseph D Tucker, Benjamin M Meier [email protected] University of North Carolina Chapel Hill Project-China, Guangzhou, China (JDT); Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (JDT); SESH Global, Guangzhou, China (JDT); Department of Public Policy, Abernethy Hall, Chapel Hill, NC, USA (BMM); and O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA (BMM) 1
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3
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Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet 2016; 16: 683–88. Transgender Law Makes North Carolina Pioneer in Bigotry (Editorial), The New York Times (New York), March 25, 2016. http:// www.nytimes.com/2016/03/25/opinion/ transgender-law-makes-north-carolinapioneer-in-bigotry.html?_r=0 (accessed Aug 5, 2016). Wylie K, Knudson G, Khan S, Bionerbale M, Watanyusakul W, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet 2016; 16: 682–86. NCAVP. Lesbian, gay, bisexual, transgender, queer, and HIV-affected intimate partner violence: national coalition of anti-violence programs, 2012. New York: New York City Anti-Violence Project, 2012. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press, 2011.
www.thelancet.com Vol 388 August 20, 2016
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Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
Institutional corruption, health-sector reforms, and health status in Nigeria According to the Global Corruption Report, 1 corr uption in the health sector is a major challenge worldwide. Nigeria, as part of the global system, is not immune from such corruption. Many health-care professionals and health-care experts in Nigeria agree that institutional corruption is a major impediment to health-sector reforms and that corruption is responsible for the lack of improvement in the health of Nigerian people over past decades.2,3 The aims and objectives of most health ministry workers, civil servants, and political actors are often misaligned with efforts aimed at reforming the Nigerian health sector to improve health status. Hence, stakeholders in the health sector need to be aware of institutional corruption, which Lawrence Lessig defined as the deliberate attempt of some individuals to make an institution ineffective by working at cross purposes to its goals thereby eroding public trust in the institution.4 Institutional corruption places a huge burden on poor people who are often unable to pay for healthcare services.5 As such, improving the health of Nigerian people should be a top priority of workers in every health institution and can be achieved by ensuring that initiatives aimed at reforming the health sector are supported without prejudice, personal aggrandisement, and perfidy. These improvements would increase public trust in the health sector, ensure the effective use of financial resources for health, and engender increased investment in health of the people.
Lack of development of previous governments’ policies by newly elected administrations has also affected the process of health-sector reform in Nigeria. Policy makers and political actors need to imbibe the culture of continuity. Innovative programmes and initiatives are needed and should work in the overall interest of the Nigerian population, who are at the receiving end of the consequences of bad management and are experiencing little or no improvement in their health status as a result. Improvements in the health of Nigerian people should be made a national priority and treated with utmost importance among decision makers. I declare no competing interests.
*Bolaji Samson Aregbeshola [email protected] Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos 23401, Nigeria 1
2
3
4
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Transparency International. Global Corruption Report 2006. http://www.transparency.org/ whatwedo/publication/global_corruption_ report_2006_corruption_and_health (accessed June 14, 2016). Adegboyega K, Abdulkareem SB. Corruption in the Nigerian public health care delivery system. SJSS 2012; 2: 98–114. Lewis M. Governance and corruption in public health care systems. 2006. http://www1. worldbank.org/publicsector/anticorrupt/ Corruption%20WP_78.pdf (accessed June 14, 2016). Lessig L. Institutional corruption. http://wiki. lessig.org/Institutional_Corruption (accessed June 14, 2016). World Bank. World Development Report: making services work for poor people. 2004. https://openknowledge.worldbank.org/ handle/10986/5986 (accessed June 14, 2016).
Telemedicine expedites access to optimal acute stroke care In their meta-analysis of patient-level data from five randomised trials, Mayank Goyal and colleagues1 (April 23, p 1723) reported that endovascular thrombectomy was effective for patients with acute ischaemic stroke caused by large-vessel occlusions
Steve Cole images
survey of transgender individuals found that 19% had been denied access to health care because of their gender identity and 28% reported verbal harassment in a medical setting.6 While we await the overturning of HB2, the vicious cycle that links institutionalised discrimination and transgender harm needs to be broken. Establishment of mandatory transgender training in medical schools and clarification of hospital discrimination policies are two key steps. These steps will become more important in 2017 when the Affordable Care Act prohibits health insurers from discrimination against transgender individuals. Health professionals in North Carolina and around the world have a responsibility to serve the needs of all, including transgender people. North Carolina’s bigotry bill serves as a powerful reminder of the need to ensure the rights that underlie health.
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We declare no competing interests.
*Joseph D Tucker, Benjamin M Meier [email protected] University of North Carolina Chapel Hill Project-China, Guangzhou, China (JDT); Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (JDT); SESH Global, Guangzhou, China (JDT); Department of Public Policy, Abernethy Hall, Chapel Hill, NC, USA (BMM); and O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA (BMM) 1
2
3
4
5
Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet 2016; 16: 683–88. Transgender Law Makes North Carolina Pioneer in Bigotry (Editorial), The New York Times (New York), March 25, 2016. http:// www.nytimes.com/2016/03/25/opinion/ transgender-law-makes-north-carolinapioneer-in-bigotry.html?_r=0 (accessed Aug 5, 2016). Wylie K, Knudson G, Khan S, Bionerbale M, Watanyusakul W, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet 2016; 16: 682–86. NCAVP. Lesbian, gay, bisexual, transgender, queer, and HIV-affected intimate partner violence: national coalition of anti-violence programs, 2012. New York: New York City Anti-Violence Project, 2012. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press, 2011.
www.thelancet.com Vol 388 August 20, 2016
6
Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
Institutional corruption, health-sector reforms, and health status in Nigeria According to the Global Corruption Report, 1 corr uption in the health sector is a major challenge worldwide. Nigeria, as part of the global system, is not immune from such corruption. Many health-care professionals and health-care experts in Nigeria agree that institutional corruption is a major impediment to health-sector reforms and that corruption is responsible for the lack of improvement in the health of Nigerian people over past decades.2,3 The aims and objectives of most health ministry workers, civil servants, and political actors are often misaligned with efforts aimed at reforming the Nigerian health sector to improve health status. Hence, stakeholders in the health sector need to be aware of institutional corruption, which Lawrence Lessig defined as the deliberate attempt of some individuals to make an institution ineffective by working at cross purposes to its goals thereby eroding public trust in the institution.4 Institutional corruption places a huge burden on poor people who are often unable to pay for healthcare services.5 As such, improving the health of Nigerian people should be a top priority of workers in every health institution and can be achieved by ensuring that initiatives aimed at reforming the health sector are supported without prejudice, personal aggrandisement, and perfidy. These improvements would increase public trust in the health sector, ensure the effective use of financial resources for health, and engender increased investment in health of the people.
Lack of development of previous governments’ policies by newly elected administrations has also affected the process of health-sector reform in Nigeria. Policy makers and political actors need to imbibe the culture of continuity. Innovative programmes and initiatives are needed and should work in the overall interest of the Nigerian population, who are at the receiving end of the consequences of bad management and are experiencing little or no improvement in their health status as a result. Improvements in the health of Nigerian people should be made a national priority and treated with utmost importance among decision makers. I declare no competing interests.
*Bolaji Samson Aregbeshola [email protected] Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos 23401, Nigeria 1
2
3
4
5
Transparency International. Global Corruption Report 2006. http://www.transparency.org/ whatwedo/publication/global_corruption_ report_2006_corruption_and_health (accessed June 14, 2016). Adegboyega K, Abdulkareem SB. Corruption in the Nigerian public health care delivery system. SJSS 2012; 2: 98–114. Lewis M. Governance and corruption in public health care systems. 2006. http://www1. worldbank.org/publicsector/anticorrupt/ Corruption%20WP_78.pdf (accessed June 14, 2016). Lessig L. Institutional corruption. http://wiki. lessig.org/Institutional_Corruption (accessed June 14, 2016). World Bank. World Development Report: making services work for poor people. 2004. https://openknowledge.worldbank.org/ handle/10986/5986 (accessed June 14, 2016).
Telemedicine expedites access to optimal acute stroke care In their meta-analysis of patient-level data from five randomised trials, Mayank Goyal and colleagues1 (April 23, p 1723) reported that endovascular thrombectomy was effective for patients with acute ischaemic stroke caused by large-vessel occlusions
Steve Cole images
survey of transgender individuals found that 19% had been denied access to health care because of their gender identity and 28% reported verbal harassment in a medical setting.6 While we await the overturning of HB2, the vicious cycle that links institutionalised discrimination and transgender harm needs to be broken. Establishment of mandatory transgender training in medical schools and clarification of hospital discrimination policies are two key steps. These steps will become more important in 2017 when the Affordable Care Act prohibits health insurers from discrimination against transgender individuals. Health professionals in North Carolina and around the world have a responsibility to serve the needs of all, including transgender people. North Carolina’s bigotry bill serves as a powerful reminder of the need to ensure the rights that underlie health.
757