Medical Dominance and Resistance in Nigeria's Health Care System.

The health care system in Nigeria remains topical because of concerns over unremitting health outcomes, such as maternal and infant mortalities and frequent epidemic outbreaks, and more recently because of regular strikes by health workers. The strikes arise mostly from disputes between medical doctors and other health workers over a range of issues, including salary levels and emoluments, leadership of teaching hospitals, and appointment of the Minister of Health. Other health workers, who allege that doctors are favored in the system, have formed Joint Health Sector Unions to confront the doctors. Both groups have frequently engaged in strikes such that, within the past decade, there has always been a strike or the threat of a strike, a situation that causes disruption of health care services. Two presidential commissions have been instituted, to no avail. With the allegations of favoritism, only government even-handedness in more carefully delineating the areas of inclusion and exclusion in accordance with available legislations may stem the rising tide. Until solutions agreeable to both parties are found, the health system and the Nigerian people will continue to suffer frustrations of avoidable disruption of services.

Gender and the reproductive rights of Tarok women in central Nigeria.

The study investigated how unequal gender relations inhibit the attainment of women's reproductive rights. It examined whether women can choose if and when to marry, who to marry/have sex with, ability to negotiate sex with spouse, and their access to family planning. Based on theoretical orientation from gender-sexuality framework, this paper employed the qualitative research design. The main respondents were female and male of various sociodemographic groups who were engaged through in-depth interviews and focus group discussion sessions. Findings show wide scale abuses of Tarok women's reproductive rights. Most of these abuses may be traced to traditional male-centred socio-cultural structures and patriarchy that help guarantee the immunity of male violators. It is concluded that in the context of unequal gender relations and dominance of patriarchy, the attainment of women's reproductive rights is a major challenge which has profound implications for life and death.

Gender and leprosy: case studies in Indonesia, Nigeria, Nepal and Brazil.

There appear to be regional differences in gender ratios of leprosy patients being diagnosed and treated. In Asian countries, more men than women are registered whilst in Africa female patients outnumber males. The Netherlands Leprosy Relief (NLR) therefore initiated research into factors underlying these regional gender differences. Between 1997 and 1999, leprosy control teams in Indonesia, Nigeria, Nepal and Brazil supported by social/public health scientists, conducted comparative exploratory research. They looked at three groups of potential explanatory factors: biological, socio-cultural/economic and service-related. The studies were partially quantitative (analysis of the records of patients who according to prescription could have completed treatment) and partially qualitative (interviews/focus group discussions with patients, their relatives, community members and health staff on perceptions of leprosy, its socio-economic consequences, treatment and cure). Biological factors appeared similar in the four countries: irrespective of the M/F ratio, more men than women were registered with multibacillary (MB) leprosy. Strong traditions, the low status of women, their limited mobility, illiteracy and poor knowledge of leprosy appeared to be important sociocultural factors explaining why women were under reporting. Yet, accessible, well reputed services augmented female participation and helped to diminish stigma, which in three out of the four societies seemed greater for women than for men. These positive effects could still be higher if the services would enhance community and patient education with active participation of patients and ex-patients themselves.

Breaking the wall of silence: AIDS policy and politics in Nigeria.

AIDS was first diagnosed in Nigeria in 1986. By that time, the government had enough information from experiences in other African countries to goad it into quickly establishing a control program. Nigeria's National AIDS Control program, however, fell victim to years of military arbitrariness and uncertainty. It was underfunded and had three directors in as many years. This arbitrariness and general lukewarm response from government occurred despite rapid increases in seroprevalence rates. Available data indicate a national prevalence of 5.4 percent and rates as high as 30 percent among some "high-risk" groups; as many as 10 to 15 persons with full-blown AIDS are admitted weekly in some tertiary facilities. Experiences in communities show an already heavy and growing burden. The nonchalance of past military regimes is gradually being reversed with Nigeria's return to civil rule in May 1999. Perhaps because of the fragmented statistics and the government's seeming conspiracy of silence, Nigeria is not included in the count of African countries with high HIV/AIDS prevalence. The author suggests that the new democratic government needs to go beyond professed commitment to demonstrable action to halt the spread and address social and other impacts of the epidemic.