Archive for January, 2013

Posted: January 29, 2013 in Uncategorized

TexTheLaw

Jurisprudence is probably the most important subject of study for would-be lawyers and anyone trying to understand how legal systems work. Jurisprudence provides the “back-story”, if you will, to why we have the laws and legal principles we have today. Theories of state and government have led to laws guaranteeing the separation of powers of government, as well as representation in government by virtue of a people’s assembly. Similarly, the evolution of thought over time on what constitutes justice has also impacted on how different societies punish crime differently. This is why, for instance, amputation as a punishment for stealing and execution for murder are acceptable in some countries and not in others.

Our legal system, including our criminal jurisprudence, like most countries in the Commonwealth, was handed down to us by the British while Nigeria was a colony. This system of law is generally referred to as “Common Law”…

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A Different Model — Medical Care in Cuba  by Edward W. Campion, M.D., and Stephen Morrissey, Ph.D.  N Engl J Med 2013; 368:297-299 January 24, 2013 DOI: 10.1056/NEJMp1215226

For a visitor from the United States, Cuba is disorienting. American cars are everywhere, but they all date from the 1950s at the latest. Our bank cards, credit cards, and smartphones don’t work. Internet access is virtually nonexistent. And the Cuban health care system also seems unreal. There are too many doctors. Everybody has a family physician. Everything is free, totally free — and not after prior approval or some copay. The whole system seems turned upside down. It is tightly organized, and the first priority is prevention. Although Cuba has limited economic resources, its health care system has solved some problems that ours has not yet managed to address.

Family physicians, along with their nurses and other health workers, are responsible for delivering primary care and preventive services to their panel of patients — about 1000 patients per physician in urban areas. All care delivery is organized at the local level, and the patients and their caregivers generally live in the same community. The medical records in cardboard folders are simple and handwritten, not unlike those we used in the United States 50 years ago. But the system is surprisingly information-rich and focused on population health.

All patients are categorized according to level of health risk, from I to IV. Smokers, for example, are in risk category II, and patients with stable, chronic lung disease are in category III. The community clinics report regularly to the district on how many patients they have in each risk category and on the number of patients with conditions such as hypertension (well controlled or not), diabetes, and asthma, as well as immunization status, time since last Pap smear, and pregnancies necessitating prenatal care.

Every patient is visited at home once a year, and those with chronic conditions receive visits more frequently. When necessary, patients can be referred to a district polyclinic for specialty evaluation, but they return to the community team for ongoing treatment. For example, the team is responsible for seeing that a patient with tuberculosis follows the assigned antimicrobial regimen and gets sputum checks. House calls and discussions with family members are common tactics for addressing problems with compliance or follow-up and even for failure to protect against unwanted pregnancy. In an effort to control mosquito-borne infections such as dengue, the local health team goes into homes to conduct inspections and teach people about getting rid of standing water, for example.

This highly structured, prevention-oriented system has produced positive results. Vaccination rates in Cuba are among the highest in the world. The life expectancy of 78 years from birth is virtually identical to that in the United States. The infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 — lower than the U.S. rate, although the maternal mortality rate remains well above those in developed countries and is in the middle of the range for Caribbean countries. Without doubt, the improved health outcomes are largely the result of improvements in nutrition and education, which address the social determinants of health. Cuba’s literacy rate is 99%, and health education is part of the mandatory school curriculum. A recent national program to promote acceptance of men who have sex with men was designed in part to reduce rates of sexually transmitted disease and improve acceptance of and adherence to treatment. Cigarettes can no longer be obtained with monthly ration cards, and smoking rates have decreased, though local health teams say it remains difficult to get smokers to quit. Contraception is free and strongly encouraged. Abortion is legal but is seen as a failure of prevention.

But one should not romanticize Cuban health care. The system is not designed for consumer choice or individual initiatives. There is no alternative, private-payer health system. Physicians get government benefits such as housing and food subsidies, but they are paid only about $20 per month. Their education is free, and they are respected, but they are unlikely to attain personal wealth. Cuba is a country where 80% of the citizens work for the government, and the government manages the budgets. In a community health clinic, signs tell patients how much their free care is actually costing the system, but no market forces compel efficiency. Resources are limited, as we learned in meeting with Cuban medical and public health professionals as part of a group of editors from the United States. A nephrologist in Cienfuegos, 160 miles south of Havana, lists 77 patients on dialysis in the province, which on a population basis is about 40% of the current U.S. rate — similar to what the U.S. rate was in 1985. A neurologist reports that his hospital got a CT scanner only 12 years ago. U.S. students who are enrolled in a Cuban medical school say that operating rooms run quickly and efficiently but with very little technology. Access to information through the Internet is minimal. One medical student reports being limited to 30 minutes per week of dial-up access. This limitation, like many of the resource constraints that affect progress, is blamed on the long-standing U.S. economic embargo, but there may be other forces in the central government working against rapid, easy communication among Cubans and with the United States.

As a result of the strict economic embargo, Cuba has developed its own pharmaceutical industry and now not only manufactures most of the medications in its basic pharmacopeia, but also fuels an export industry. Resources have been invested in developing biotechnology expertise to become competitive with advanced countries. There are Cuban academic medical journals in all the major specialties, and the medical leadership is strongly encouraging research, publication, and stronger ties to medicine in other Latin American countries. Cuba’s medical faculties, of which there are now 22, remain steadily focused on primary care, with family medicine required as the first residency for all physicians, even though Cuba now has more than twice as many physicians per capita as the United States. Many of those physicians work outside the country, volunteering for two or more years of service, for which they receive special compensation. In 2008, there were 37,000 Cuban health care providers working in 70 countries around the world. Most are in needy areas where their work is part of Cuban foreign aid, but some are in more developed areas where their work brings financial benefit to the Cuban government (e.g., oil subsidies from Venezuela).

Any visitor can see that Cuba remains far from a developed country in basic infrastructure such as roads, housing, plumbing, and sanitation. Nonetheless, Cubans are beginning to face the same health problems the developed world faces, with increasing rates of coronary disease and obesity and an aging population (11.7% of Cubans are now 65 years of age or older). Their unusual health care system addresses those problems in ways that grew out of Cuba’s peculiar political and economic history, but the system they have created — with a physician for everyone, an early focus on prevention, and clear attention to community health — may inform progress in other countries as well.

Posted: January 23, 2013 in Uncategorized

Social Crusader

While our fingers are crossed

“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction.” – John F. Kennedy

I have been opportune to travel to some places within this country and as such I think I can say I’ve seen my share of sights. I have seen poverty in its raw form, I have seen people dying of diseases in a manner that shakes even the most heartless of men to their very core, and yes I’ve seen starvation in a nation of plenty. In these same places, I have seen perhaps the highest level of ‘hope’, ‘happiness’, and ignorance-induced contentment.

My rambling today is not supposed to make anyone feel better or to stoke anyone’s ego; it is to serve as a jab at our sides to re-awaken us to the urgency of now. It is disheartening that…

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You can read and download a copy of the Nigerian National Health Bill here: NATIONAL HEALTH BILL

Please check out the 2013 Nigerian Health Budget and then see here for my commentary and analysis!

Your comments are welcome as always!

Cheers 🙂

HEALTH BUDGET REVIEW AND COMMENTARY by Chijioke Kaduru

1. Summary

The health budget has a number of remarkable highlights, and is seen to show rich investment in key areas, especially in regards to scaling up maternal and child health services. There is also some significant investment in improving a number of the federal health facilities across the country. The budget is however riddled with only 20% capital expenditures, numerous duplications and inconsistencies, inadequate investment towards universal health coverage and an inclination towards catering for the upper class and the civil servants, more than the masses. Special effort must be made to re-distribute the excesses and wastes within the budget, and increase capital expenditures, as well as aim to invest more in catering for the health care needs of the most vulnerable, of our society. It will also be imperative, to encourage government to provide a more significant allocation to health, than the less than 6% of total national expenditure for the coming fiscal year.

2. Initial Observations

  • Only 20% of the total budget goes to Capital expenditures
  • 6% of the total health budget is being spent on the Ministry Of Health Headquarters alone
  • Less than 2% of the total budget is being spent to make health care affordable to the masses, through the functioning of the National Health Insurance Scheme (NHIS) and the provision social health insurance
  • Institutes of Child health get no capital expenditures, and only have recurrent expenditures. Considering the need to scale up research and interventions in the area of child health, as well as our poor child health indices, you would expect more significant investment across the institutes of child health
  • Capital expenditures for National Hospital, a relatively expensive teaching hospital, designed to cater mostly to the Abuja elites is about twice the capital expenditures of any of the other Federal hospitals (with the exception of Ahmadu Bello University Teaching Hospital, Zaria). This is a huge discrepancy, considering the population balance and the strategic geo-political locations of some of the other Federal hospitals
  • Lots of duplications in the overhead costs of the Ministry Of Health Headquarters, the strategic agencies and across most of the federal centers in the country
  • A disconnect in health spending, in the sense that some of the expenses captured in the budget, should be clearly overseen and funded at the local and state government levels, who would most likely be providing budgetary allocations for some of the same projects
  • Budget is over-zealous in some places and so you would expect more ambitious primary health care projects, or bigger investments in social health insurance, which are surprisingly absent

3. Commendable Highlights

– Significant investments in maternal and child health through investments in

  • On-going procurement and distribution of contraceptive commodities;
  • Capacity building for service providers and information management;
  • Implementation of integrated, maternal, newborn and child – health strategy: bi-annual Maternal & Child Health week, capacity building, etc.
  • Promoting school health initiatives, quarterly issue for family health programs;

– Significant investments in HIV/AIDS control through investments in

  • HIV/AIDS control: expansion of access to treatment, care and support to People living with HIV/AIDS;
  • Establishment, assessment and upgrading of addition 100 care sites nationwide, HIV test kits etc.

– Investment in vulnerable group social health insurance program, tertiary institutions social health insurance and piloting of community based social health insurance programs in 148 communities

4. Waste & Loopholes in the Budget

– Overhead costs in the Ministry of Health Headquarters, including expenses on “Magazines and Periodicals”, “Drugs and Medical Supplies”, some of which are irrelevant, as they are covered in other aspects of the budget, or appear to have been over-budgeted for

– Overhead costs that are not entirely comprehensible, such as “Motor Vehicle Fuel cost” vs. “Other transport equipment fuel cost” in Ministry Of Health Headquarters and National Primary Health Care Development Agency overhead costs. What other transport equipment is not a motor vehicle? And why do those other transport equipment cost seven times as much to fuel (as is the case in the Minister of Health Headquarters overhead costs)?

– Duplications in expenses, and some examples would include

  • “International Travel & Transport: Training” vs. “International Training” seen in the overhead costs of a number of the agencies, including the Ministry of Health Headquarters
  • “National Center for Disease Control (NCDC): Equipping the NCDC building at Gaduwa district, Abuja; Operationalization of the NCDC, etc.” vs. “MDG support for establishment of the National Center for Disease Control (NCDC), among the Ministry Of Health Headquarters capital expenditures
  • “MDG-support for strategic health management system strengthening (HSS)” vs. “MDG support for strategic health management system strengthening including support for the prevention and control of communicable diseases in Nigeria (SCD)” among the Ministry Of Health Headquarters capital expenditures
  • “Ongoing projects – Routine immunization (procurement of vaccines, including new vaccines for children below 1 year and pregnant women)” vs. “MDG projects ongoing – Routine immunization (Procurement of vaccines, including new vaccines for children below 1 year and pregnant women)”, among the National Public Health Care Development Agency capital expenditures

– Expenses, which should and probably will belong to the budget of a different entity, such as the state or local governments, or the institutions themselves, but are rather budgeted for in the Ministry of Health Headquarters capital expenditures. Some examples would include

  • Pre-installation works, upgrading and modernization of tertiary hospitals (UATH Abuja, ATBUTH Bauchi, UUTH Uyo and ISTH Irrua, FETHA Abakaliki) and upgrading of National Hospital to Quarternary hospital
  • Procurement of Narcotic drugs by Minister of Health Headquarters
  • Payment for 10 no. CT scan machines at some Federal Medical Centers (FMCs) and installation of the 10 no. CT scan machines.
  • Construction of health center in Uruezeani town, Alor in Idemili-South LGA of Anambra State.

– Presidential pledge of $10 million (NGN 1.6 Billion) to Global Fund, from a country that lacks investment in significant strategies to curtail the same diseases being addressed by the Global Fund. Money that would better serve us, if invested in Malaria, TB and HIV programs within the country. This allocation is captured in the Ministry of Health Headquarters capital expenditures, under “MDG Malaria program: Procurement and distribution of insecticide treated bed nets to Kogi, Delta and Osun and contribute to presidential pledge of USD10m to global fund”

– Discrepancies in certain exact expenses, across centers in the country, leading to a suspicion of significant over-budgeting in some centers. An example would be in the amount being spent on maintaining generators and purchasing new ones by some of the hospitals: University of Ilorin Teaching Hospital for example, has budgeted NGN54,256,701 to maintain and at the same time NGN21,414,490 to purchase a new one. When compared to UCH, Ibadan, a much bigger hospital’s NGN4,000,000 to maintain and NGN20,000,000 for a new purchase, and the amounts quoted by other centers, an obvious inconsistency can be noted.

5. Recommendations

  • Complete purgation of the duplicated expenses
  • Review of the overhead costs of a number of agencies
  • Scale up the amount being invested in the Social Health Insurance
  • Rescinding the presidential pledge to global fund
  • Review of expenses that are by design meant for the state and local governments
  • Investment in progressive digitalizing of Health Records considering cost of maintaining a Health Records Officers’ Registration Board of Nigeria
  • Rechanneling of the funds into more capital projects, especially in the area of maternal and child health, in line with the National Strategic Health Development Plan

It is hard to believe, but a child’s future can be determined years before they even reach their fifth birthday.

A child’s potential can be greatly enhanced or just as equally limited, within the first five years of their life. These years comprise the most fragile years and are the gateway to the formative years of a child’s life.  Securing the future for our children, and indeed a country, requires that extra attention must be paid to these formative years. It also means, that we as young people must take up a role in advocating for the healthcare and other needs of these children, as the future of all our efforts is theirs to hold and cherish.

According to the UN Inter-agency Group for Child Mortality Estimation, some eighty percent of the world’s under-five deaths in 2011 occurred in only twenty-five countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India (24%) and Nigeria (11%) together, account for more than a third of under-five deaths worldwide.

Under-five mortality rate is defined as the probability of dying by age five expressed as the total number of such deaths per 1000 live births. It is strictly speaking, not a rate but a probability of death derived from a life table. It is a leading indicator of the level of child health and overall development in countries. It is also a Millennium Development Goal indicator. According to the World Health Statistics 2012, Nigeria has a rate of 143 per 1000 live births, Ghana 74, DR Congo 170 and a rate of less than 20 across most of Europe.

The Federal Minister of Health listed achievements in the health sector, in a Guardian article on 13th September 2012, most of which were hugely underwhelming as there were not enough short or long term benefits to the health & healthcare of our children, lacing these achievements. They mostly comprised the adoption of a National Strategic Health Development Plan, promises of a Health Sector Performance Report in the coming months and numerous committees, task forces and on-paper strategies.

However, some concrete improvements can so far be appreciated and the federal ministry of health must be given due credit for these milestones. Some of these achievements include doubling the funding of Polio Eradication activities to N4.7 billion, compared to 2011, the introduction of the new Cerebrospinal Meningitis vaccine, the new trauma centers in University of Abuja Teaching Hospital and the National Hospital nearing completion, modernization of some Federal Teaching Hospitals to apparently international standards (Sokoto and Kano are inaugurated, Ile-ife and Benin are completed, Nnewi and Calabar are at advanced stages), introducing the National Centre for Disease Control (NCDC) and a few others.

New and or improved health facilities, and increased investment and effort in immunization schemes, are remarkable steps towards improving our health and the health of our children and should be applauded.

Having taken a look at some of the achievements in the Nigerian health sector today, some key issues arise on how these achievements are affecting people at the grassroots, how it is contributing to a guaranteed future for our children and our country and if the most relevant issues are being addressed in ensuring the health of our children.

An in-depth analysis of the health and socio-economic designs of our country, will most likely show that the biggest killer of our people, and especially our children, is the really small matter of universal health coverage or a lack of it.

Universal health coverage is defined as: ensuring that all people have access to needed health services – prevention, promotion, treatment and rehabilitation – without facing financial ruin because of the need to pay for them.

If parents cannot afford to pay for health care, or will go broke from accessing health care for these children, then the battle for childhood survival, within our circumstances, appear to already be lost.

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According to the World Health Organization, three fundamental, interrelated problems restrict countries from moving closer to universal coverage. Firstly, the availability of resources, as no country, no matter how rich, has been able to ensure that everyone has immediate access to every technology and intervention that may improve their health or prolong their lives. Secondly, an overreliance on direct payments at the time people need care, which include over-the-counter payments for medicines and fees for consultations and procedures – whether that payment is made on a formal or informal (under the table) basis. Thirdly, the inefficient and inequitable use of resources, as at a conservative estimate according to the WHO, 20–40% of health resources are being wasted.

The World Health Assembly resolution 58.33 from 2005 says everyone should be able to access health services and not be subject to financial hardship in doing so. The data on the extent of financial catastrophe and impoverishment associated with direct out-of-pocket payments for health estimates that each year up to 10% of the population in many countries suffer financial catastrophe, with up to 4% pushed under the poverty line, due to healthcare related payments simply because they use health services for which they are forced to pay out of their own pockets.

Imagine having total savings of NGN100,000, and a family of 2 kids of primary school age. An acute illness requiring hospital admission for a week, drugs and laboratory investigations for 1 child, could cost as much as NGN50,000 in a federal hospital. How much then of one’s savings are left?

Without financial risk protection in health – the assurance that they will not suffer severe financial problems if they need to use health services – people will defer seeking care or not seek it at all.

The bottom line then is that, even if adequate services are provided to safeguard the health of our children, the fear of financial hardship from seeking healthcare will consistently deter parents from seeking healthcare for these children. If these children cannot get healthcare, then our future as a nation is not secure.

What then can we do to help these children and to safeguard their parents from the financial risks of seeking healthcare?

Health financing is one of the eight priority areas of the Nigerian National Strategic Health Development Plan, rubber stamped by President Goodluck Jonathan. The National Health Insurance Scheme (NHIS) is very central to health care delivery in the country and the health ministry has supposedly put a lot of effort to upscale coverage. There is the community health insurance scheme, and the Voluntary Contributory Health Insurance, all aligning to reduce out-of-pocket payments. Out-of-pocket payments currently account for 62% of total health spending in Nigeria (World Health Statistics, 2012).

However, the government has failed to deal with or do enough in certain core areas, surrounding making health care affordable to our children and their parents.

Increased funding of the health sector and limiting misuse of health resources

With very low levels of funding, we cannot ensure universal access to even a very limited set of health services. On the other hand, higher levels of funding might not translate into better service coverage or improved health outcomes if the resources are not used efficiently or equitably.

The National Health bill, not necessarily a holy grail, will definitely change the direction of health & health care in Nigeria, if implemented. It guarantees financial commitment from the federal government, commitment to essential health pillars, limitation of resource wasting and engagement of the grassroot in subsequent health policymaking.

The bill specifically promises to provide all Nigerians with a basic minimum package of health services and pledges to develop a national health policy that includes 60 billion naira (about US$380 million) devoted to primary health care each year, provision of essential drugs, and comprehensive vaccination programs for pregnant women and children younger than 5 years of age.

A former health minister, Professor Adenike Grange said 5 years ago and I quote “….the absence of a National Health Act to back up the National Health Policy has been a fundamental weakness which needed to be tackled frontally. This weakness means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions

While National Assembly debated the bill from 2003 – 2011, the Nigerian Medical Association estimated that 7 million children and 385,000 mothers died in the interim. The bill has now been seating on the desk of the President since May 2011 and remains unsigned, with no explanations provided to the masses. How many more children will die before the bill gets signed, is anyone’s guess.

 

Supplementary funding approaches

Several additional funding approaches for health care, are being used by many countries including Robin-hood taxes, taxes on mobile phone ownership/airtime usage or mobile money, increased value added taxes, excise taxes on tobacco and alcohol, and/or insurance premiums and other exemplary schemes. These prepayment approaches, with subsequent pooling of available financial resources spread the risk across the population, and help to ensure that people can use health services without fear of financial ruin.

 

Adequate education of the masses on the issue of health insurance

This basic concept behind health insurance needs to be explained at great length and effort to the masses, to win them over and get them to subscribe. The people will have to take on a paradigm shift that ensures looking out for one another through risk sharing and crowd pooling of resources for health needs. The government will however need to educate people, as well as be the role model in this desired paradigm shift.

 

Increased effort towards providing health insurance for students, workers outside of civil-service and the unemployed

In Nigeria, as in every country, a proportion of the population is too poor to contribute via income taxes or insurance premiums. They will need to be subsidized from pooled funds, generally government revenues.

The health ministry is putting some effort into this already. However, there is still a huge gap that needs filling. Ultimately, universal coverage requires a commitment to covering 100% of the population, and plans to this end need to be developed from the outset even if the objective will not be achieved immediately.

Universal coverage with needed health services maintains and improves health. Good health allows children to learn and adults to earn. It helps people escape from poverty and provides the basis for long-term economic development. At the same time, financial risk protection in health prevents people from being pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their own futures and often those of their children.

“No one in need of health care, whether curative or preventive, should risk financial ruin as a result” – Margaret Chan, WHO Director General

If Nigeria as a country would like to guarantee its future, we must seek to promote and protect our health and most especially, the health of our children.

We as a people, have to become and remain accountable to this country’s children. A first step is to ensure that they can access healthcare without the deterrent posed by out-of-pocket payments.

Posted: January 8, 2013 in Uncategorized

Raymond Eyo's Blog

“We are not all PDP. I disagree with Ohimai. We don’t all belong to a party of murderers, looters and political juggernauts.” –Babatunde Rosanwo

As an avid reader and a very politically-conscious person, I read Ohimai Ahaize’s article, Like it or not, we are all PDP: http://www.ynaija.com/ohimai-amaize-like-it-or-not-we-are-all-pdp-y-politico/, with keen interest and an open mind. Ohimai acknowledged that it was his first article in three years or so. That set the tone for the seriousness with which it was written, which seriousness was not betrayed by the article’s overall compelling message. I therefore invite Ohimai and indeed everyone to equally accord this rejoinder, interspersed with citations on the subject from Babatunde Rosanwo, the open-mindedness and seriousness it deserves.

Ohimai articulated cogent and valid arguments but betrayed his bias for the PDP when he said “The current fad is how well you can demonise the ruling People’s Democratic Party (PDP). I…

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Gays, Lesbians and Legislative zealotry

by Wole Soyinka

LET us go back a little, nearly a year ago, to that earlier attempt to interfere in, and legislate on sexual conduct between consenting adults. Profiting from that experience, I would like to caution – yet again – that it is high time we learnt to ignore what we conveniently designate and react to as ‘foreign interference’.  By now, we should be able to restrict ourselves to the a priori  position that, as rational beings, we make pronouncements on choices of ethical directions from our own collective and/or majority will, independent of what is described as ‘external dictation’. The noisome emissions that surged from a handful of foreign governments last year should not be permitted to obscure the fundamental issue of the right to private choices of the free, adult citizen in any land – Asian, African, European etc. Those external responses were of such a nature – hysterical, hypocritical and disproportionate – that, speaking for myself at least, I could only wonder if they had not been generated by a desperate need for distraction away from the economic crisis that confronted, at that very time, those parts of the world.

Hopefully, the majority of Nigerians have also learnt to sniff out ploys of legislative distraction within the nation.  At that initial attempt to cloak prurience in legislative watchfulness, the timing of the removal of the oil subsidy was coincident with a sudden obsession with homosexual and lesbian conduct. Was this truly an accident of timing?  And now? Attempting to mobilize public sentiment against what many, admittedly, do consider deviant sexual conduct certainly takes attention away from the crumbling of society and the failures of governance in multiple directions. These range from minimal infrastructural expectations to mind-boggling escalation of corrupt practices in high places, and the basic issue of security in day-to-day existence of the populace as it affects high and low, affluent or impoverished, old and young, regardless of profession or records of service to Nigerian humanity.

But, to begin with, I implore all those who boast the capacity for reason: let us separate two distinct, albeit related issues within that one bill tabled before our legislatures. One issue is: homosexual practice; the other, same-sex marriage. I first became aware of, and alarmed by, the conflation of the two – quite deliberate in most cases – when, after a lecture at the University of Technology, Calabar,  a year ago, I advised the legislators to mind the numerous, and urgent businesses for which they were elected, and take their noses out of sexual practices between consenting adults.  Either deliberately – as I have already indicated – or thanks to the now familiar deficiency in listening that sadly characterizes Nigerian responses to public pronouncements, the main reactions were unleashed against something I had not even commented upon, which was:  same-sex marriage. With the now confirmed outing of this bill however, the law-makers have served notice that their monitoring zeal is intended at nothing less than the right of state interference in private lives, especially in personal relations of the most intimate kind. This is the warning shot of legislative fascism. It has no place in a democracy.

Basically, such legislations constitute improper encroachment on personal lives, leaving the door wide open for all forms of social persecution, intimidation and even – as we know very well in this society – incitement to violence against targeted individuals, including lynching.  Next, as several nations all over the world have come to acknowledge after centuries of blindness and hideous injustice, such state interventions glorify ignorance of the science of the human body, and contribute to the elevation of limited or zero knowledge on any subject to the altar of the morally sacrosanct.

The biological truth is this: some are born with imprecise gender definition, even when they have sexual organs that appear to define them male or female. Years, indeed decades, of scientific research have gone into this, so what is needed is understanding and acceptance, not emotionalism and the championing of ‘moral’ or ‘traditional’ claims.  Let us take the first. For those who base their position on moralities extracted from received scriptures, permit me to state bluntly that articles of faith are no substitute for scientific verities, no matter how passionately such faiths are embraced or espoused, or for how long. In any case, faith is also a very private matter, so what we have here is simply one private plaintiff, a ‘conscientious objector’, attempting to lord it over the rights of another private entity, this time one that yields to sexual impulses in obedience to Biological Scriptures. Now, which one should lay claim to precedence?

We must make up our minds where we belong.  We must choose either to create a society that is based on secular principles, or else surrender ourselves to the authority of – no matter whose – theocratic claims. What this implicates is that the next time a woman is sentenced to be buried live in the ground and stoned to death on the authority of one set of scriptures, other scripture adherents must learn to hold their peace and allow such ‘laws’ to run their course. The full implications of either position leave no room for fence-sitting. The national train must run either on secular rails or derail at multiple theocratic switches. No theology can be privileged over another in the running of society.  This means, theology and its derivates cannot be privileged over material reality and its derivatives.

The science of the body is not limited to issues of consenting adults alone. It is what guides the making of laws in rational societies, what makes the law frown decisively on sexual relations with the under-aged, and spells out just what the law means by ‘underage’ in specific years of existence. Adult males earn several years in prison for sexual relations with the under aged because scientific knowledge has identified – beyond argument – the often irreparable damage that is done to a pre-pubescent body through sexual penetration by males. Society therefore protects the potential victim. Has an adult homosexual run to the law for protection in any society we know of? Only where they have been, or are in danger of becoming victims of rape – and there, the law is firmly on their side. Otherwise, the law should have no interest whatsoever in any form of consensual sexual conduct between adults.

So far, we have only addressed the issue of the homosexual act itself as it should concern – or should not – a nation’s legislatures.  Let us now turn to the related problem of same-sex marriages. My interest is not – as a hysterical prelate, among others, tried to over-simplify in his reaction to my observation in Calabar – it is not whether or not homosexual marriages should be permitted or banned. Let us take it step by step.  The issue, to start with, is – ‘criminalisation’!  Perhaps such marriages exist in Nigeria – I am not aware of them. But we do know that homosexual liaisons exist. Are they granted the status of marriage? Not that I am aware of. Was there a threat somewhere that this might soon happen? Are they a menace to society? Again, all this is shrouded under legislative mystery. No case, to the best of my knowledge, has been brought to public notice where a court registry has been compelled to register same-sex marriages. No priest has been hauled up so far for sanctifying such a marriage. Always open to debate is the right of institutions (civil or state) to be part of the formal mechanisms for pledges that adults undertake in their relations with one another. Priests – of any religious adherence – remain free to refuse to become involved in the ceremonies of such associations. Individuals cannot be compelled to endorse such conduct. It remains their right to privately ostracize or embrace such liaisons – formal or informal. The state however overreaches itself where it moves to criminalize them. Biology takes precedence over ‘moral’ sentiment. Physiological compositions are increasingly held responsible for a number of mental and/or physical predispositions. Only in the past few decades was schizophrenia successfully tracked backwards to – among other causes – the contraction by mothers of some forms of ailment during pregnancy, as well as to genetic transmission. We should learn to listen wherever the voice of the empirical can be called upon to testify in human conduct.

On the ‘moralists‘, we urge a sense of proportion, and a turn towards objectivity. Yes, a society without moral signposts is only a glorified arena of brute instincts. Nonetheless, morality is far too often mired in subjectivity, sometimes touted as ‘revelation’, erected on untested foundations, increasingly subject to mass hysteria and manipulation. Morality therefore – we must re-emphasize – when applied to the private realm of the human body,  must take second place to biology – morality either as derived from cultural usage or religious givens. We are speaking of – plain biological human composition, over which no individual has any control whatsoever. No individual was responsible for his or her birth, for emerging as a precocious being, a budding genius, or handicapped – either mentally or physiologically.  Those who evoke ‘morality’ so loosely should take care that they do not keep company with theocratic warlords like al-Shabaab of Somalia, who instituted amputation at the wrist for anyone found guilty of the ‘immoral’ act of shaking hands with a fellow human being of the opposite sex!

Permit me to address some of the anxieties – publicly addressed or not – that I happen to have encountered. No one denies the perverse agency of ‘peer pressure’ in certain societies – or institutions – where homosexuality is considered ‘fashionable’, or even becomes a membership card for advancement in some professions.  It is also the admissible right of the individual to experience and express disgust at the mere thought of homosexual conduct: the complement, incidentally, also obtains among some homosexuals with regard to heterosexual practice. I have encountered some who declare that the very thought of heterosexual act makes them sick.  Also, there exist the bi-sexual individuals who live and die at ease – or with resignation – with their complex anatomy. None of these tendencies justifies criminalization. The heterosexual – or ‘straight’, to use that tendentious expression – minds his or her business like the rest. Laws, if any are promulgated in these cases, should be towards the protection of the vulnerable in society, vulnerable from whatever cause, including deviations from the sexuality of the majority genders. Non-consensual conduct is a different matter, or coercion, such as rape or other forms of sexual abuse, and these apply both to the homosexual and the heterosexual. I have had occasion to intervene in boarding schools to demand protection for some young pupils whose lives were bedeviled by sexual harassment from their senior colleagues. Their teachers turned a deaf ear to the victims’ complaints to an extent that virtually amounted to connivance. Now that is one area against which legislators might usefully want to turn their legislative ire – such teachers deserve to be brutally purged from their positions and made to face prosecution.

I shall be remiss if I do not also to address the appalling evidence of hypocrisy among the law makers. New laws are being proposed for private conduct that has never constituted a danger to the fabric of society. By contrast, the notorious violation of existing laws by a member of the law-making fraternity was rendered a non-event by a conspiratorial silence, amounting to connivance and enthronement of impunity.  A former governor and present Senator violated the laws of two lands – Egypt and Nigeria – through his sexual behaviour. Serial paedophilia and cross-border sex trafficking are criminalized near universally. Laws for the protection of minors are rigorously enforced in civilized societies. On that, and allied issues, the law-making conclaves of wise men and women remained mute or conciliatory. An opportunity to enforce the existing laws in high places as a high profile deterrent to others was simply discarded. No new laws have been proposed, not even as a sop to outraged public conscience, to re-criminalize such acts, yet the legislatures take time off to make laws that criminalize private conduct that have not constituted a threat to the well-being of the vulnerable in society.

Is it too much to ask that our legislators cool their moral ardour for a study period during which they seek to understand a phenomenon that many hold abhorrent? (Please note: this is not intended as yet another incentive to undertake expensive study tours around the world – the relevant publications are available everywhere.)  If there are scientific explanations for homosexual conduct —  and these have been expounded in profusion — then a process of education is called for, enabling a more empathetic response to what appears an aberration to the majority. That it appears an aberration to some does not however make it immoral or socially subversive.  And foreign interventionists should – let me repeat – at least exercise a sense of proportion, recalling that even within their own societies, such issues are still up for debate, with see-saw decisions between state and federal courts – examples include the United States – right up to the present. The high moral grounds that those nations attempt to occupy by hurling threats of sanctions etc etc. merely strike one as extreme cases of hypocrisy, unmindful of their own scriptural injunctions that urge: ‘Physician, heal thyself ”

This article was previously posted here http://www.ynaija.com/wole-soyinka-gays-lesbians-and-legislative-zealotry/