CALL TO 
IMPROVE HEALTH CARE SERVICES IN THE RURAL
COMMUNITIES IN NIGERIA
A MEMORANDUM SUBMITTED TO THE
JOINT COMMITTEE ON RURAL DEVELOPMENT
AND HEALTH CARE SERVICES
HOUSE OF REPRESENTATIVES
NATIONAL ASSEMBLY, ABUJA, NIGERIA
ON
THURSDAY, 24 MAY 2018
BY
DR. UZODINMA ADIRIEJE, CMC, CMTF, FIMC, FNAE, FIL, MNIM
Ugwumba I, Ahaejiejemba of Amaruru
(Health Economist, Advocate, Trainer/Facilitator, Evaluator, Health & Dev’t
Systems
Strengthening specialist, Researcher, Writer/Columnist, Community Leader)
CEO/National Coordinator
AFRI-HEALTH OPTONET ASSOCIATION
-
a CSOs network &
think-tank for Health, Community & Dev’t Systems Strengthening
-
an NGO with Consultative
Status at the United Nations ECOSOC
MEMORANDUM
ON THE
CALL
TO IMPROVE HEALTH CARE SERVICES IN THE RURAL COMMUNITIES
To: The
Chairman, House of Representatives Joint Committee on Rural Development and
Health Care Services, National Assembly,
Abuja, Nigeria
From: Dr.
Uzodinma ADIRIEJE, CEO/National Coordinator, Afrihealth Optonet Association
Date:
24 May 2018
Subject:
Improving Health
Care Services in the Rural Communities in Nigeria
PRESENTATION
OUTLINE
I. PROTOCOLS page
3
II. INTRODUCTION
AND BACKGROUND page
3
III. HEALTH
CARE SERVICES, RURAL COMMUNITIES AND
THE SUSTAINABLE DEVELOPMENT GOALS (SDGs) page 5
IV.
OUR VIEWS AND SUPPORT FOR THE PROVISIONS
OF THE BILL page 5
V.
CLOSING COMMENTS page
9
I. PROTOCOLS
II. INTRODUCTION
AND BACKGROUND
Two days ago, I returned from a week-long working visit to
Sokoto as Technical Assistance to the Sokoto State Government; to support the
Sokoto State Contributory Healthcare Management Agency (SOCHEMA) in commencing
the implementation of the Sokoto State Healthcare Management Scheme. This is
one effort to extend and expand the provision and accessibility of Health Care
Services to all the residents of the State but most importantly those in the
rural areas.
Like most States in
Nigeria, Sokoto is essentially an agricultural state with
traditional mode of production predominating and more than 90 percent of the
population engaged in subsistence farming. It has a 2016 population estimate of
4,998,100. The
health sector is characterized by wide disparities between the state capital
and rural areas in status, service delivery, and resource availability. More
health services are located in the Sokoto metropolis (Sokoto North and Sokoto
South) than in the remaining 21 local governments outside the metropolis.
Aware
that risk coverage is difficult
to provide in States and countries with vast rural areas, scattered population
and low money incomes; the Sokoto State government and people have included
Community-Based Contributory Health Programme in the Scheme. This programme
shall work with Ward Development Committees (WDCs), Leaders of Market Women
Groups across the State, Community-Based Organizations [CBOs], Faith-based
groups, Rural Artisans, etc., as entry point to increase uptake of primary
health care (PHC) and outreach services by enrollees, especially in the rural
areas of the State. The Scheme also aims to strengthen the functions of WDCs in
the political wards of the State to provide stewardship role for health care
services in their respective wards to ensure the success of the Scheme in
providing the approved Basic Minimum Health Care Package [BMHCP] for every
resident of Sokoto State.
The
State is working to provide cover for all residents within the formal and
informal sectors, including vulnerable persons [i.e. persons who due to their
physical status (including age) cannot engage in any meaningful economic
activity], such as physically challenged persons, persons aged 65 years and
above, children under-five years of age, refugees, victims of human trafficking,
and pregnant women and orphans for who the State will bear responsibility for
the BMHCP.
I
have brought up the position of Sokoto State and its effort to provide health
care for its rural dwellers because Sokoto is adjudged as the poorest State in
Nigeria. So, if the poorest State in the country can afford to make such a
noble effort towards assuring Universal Health Coverage (UHC) for its citizens,
and so be on the positive highway towards achieving the Sustainable Development
Goals (SDGs), it will follow naturally that every State in Nigeria can afford
to do even better. So why not? Why is it that the Federal Government and States
which are richer than Sokoto State have not instituted justiciable mechanisms
to provide the BMHCP for all the residents of the Country/States? We will
return to this shortly.
Nigeria currently has
a population estimated of about 200 million. 1 in 10 Nigerian children below
the age of five years die annually (2300 every day) Our Maternal Mortality Rate
(MMR) of 814 per 100,000 live births by 2015 estimates makes Ghana a
sub-regional destination of choice for health seekers including Nigerians, and paradise
for expectant mothers at 319/100,000. In Italy, the MMR is 4/100,000. Life
expectancy is 54 years in Nigeria and 62 years in Ghana. Nigeria’s best ranked
hospital is the Psychiatric Hospital in Aro (2091 position in the world and 6th
best in Africa). Does this say anything about our mental state?
Our country appears to
be giving life to the biblical saying that for the person who has less (and is
not diligent), even the little he/she has shall be taken away; if we recall
that our doctor/patient ratio is among the lowest in the world, and yet we are
suffering brain drain in our health sector. Nearly 45% of physicians registered
with the Nigerian Medical Council have left the country and a large chunk of
Nurses will be retiring within a decade with no experienced hands to replace
them. These catastrophic and perplexing healthcare indices are worsened by
the continuing brain drain from Nigeria of qualified health care personnel
seeking greener pastures or retirement abroad.
Within our shores,
access to primary health care or qualified primary care personnel as well as to
the BMHCP remains a mirage for the majority of the citizens. In the absence of
fully implemented nationwide UHC, the next medical diagnosis is could mean a
death sentence or financial ruin. Presently, just about 5% of the population is
enrolled in the National Health Insurance Scheme (NHIS) and mainly public
service workers, our health systems is frequently embroiled in some industrial
action in addition to being grossly under-equipped, ill-staffed and poorly
funded by all the tiers of government. Most health care facilities especially in
the rural areas are of less status than “mere consulting clinics”. The private
landscape is littered with stand-alone one-man operations and poor referral
system which means most needy people will resort to the spiritualists and
charlatans for health care needs.
III. HEALTH CARE
SERVICES, RURAL COMMUNITIES AND THE SUSTAINABLE DEVELOPMENT GOALS (SDGs)
The 2016
national census estimates provided that 51.4% of Nigeria is rural. Nigeria is a
high priority country for almost all the major preventable diseases including
HIV/AIDS, TB, Malaria and these sicknesses occur and kill our compatriots
mostly in the rural communities. Most health problems emanate from and exact
their greatest impacts in rural areas. Fewer health care facilities and
appropriate health services are available in rural areas. Death from ill-health
and preventable diseases are more in the rural areas. Infrastructural and human
development is least in the rural areas. Majority of us now living in the urban
areas (including me) will eventually end our life destination in the rural
areas. It therefore follows that the levels of development in our rural
communities and availability and access to health care services in rural
communities are very critical determinants of how well our country’s SDG targets
can be achieved. The more success we make in them, the more likely we can
achieve our SDG targets. The possibility of the reverse should never be
contemplated!
IV. OUR VIEWS AND
SUPPORT FOR THE PROVISIONS OF THE BILL:
We are in tandem with
the authors and sponsors of this Bill. We specially note and appreciate the
emphasis of this Bill on several important issues including the following:
a. That
80% of those responsible for Nigeria’s sustainable agriculture live in rural
communities;
b. That
Agriculture is pivotal to developing Nigeria’s economy hence the Federal
Government’s ‘Green Alternative 2016-2020’ to build 23% of GDP from agriculture
c. That
the farming population in the rural communities are key to realizing the ‘Green
Alternative’, and need to be in good health in order to play such vital role;
d. That
the ‘Right to Health’ is a basic human right of the farmers in the rural
communities, which has been alluded to in various laws in Nigeria;
e. That
poor health condition is a constraint to agricultural productivity
f. That
there is a huge lack of equity in planning and distribution of health services
In order to realize the
very objectives and intentions of the Bill therefore, we support ‘Improving
Health Care Services in the Rural Communities’ and submit for your
considerations, the following approaches that have worked in making this
possible in other countries:
a. Provision
of Rural Infrastructure and Incentives for Health Care Workers: We
posit that in order to improve health care services in the rural communities,
we MUST have the rural population as our target for partnerships/colloboration,
advocacy and social mobilization, research and evidence-generation, capacity
development, outreach intervention and routine monitoring and evaluation
(M&E) of the health services and health service environments. The following
approaches/stratagems have worked in several other countries and shall also
work in Nigeria: Improve rural
infrastructure by providing minimal infrastructure and amenities for basic
comfort including reliable power supply, portable water supply, fairly good
nursery and primary schools that will attract young health care professionals
and help them make good family beginning in rural areas. This will also help
our country reverse or at least stop/reduce the rural-to-urban drifts of health
personnel and persistent lack of functional health systems in rural health
facilities – factors that prevents us from attracting and retaining the right
kind of health human resources including family physicians, nurses/midwives,
pharmacists, medical laboratory scientists, etc. in each of the facilities. We
have to also incentivize the posting to rural areas by paying them about twice
the normal pay for those in the cities. Improved electricity supply to rural
communities to encourage qualified health professionals to serve there, and
also support health commodities remain in good condition/temperature over time.
b. Accessibility
of Health Care Facilities:
The importance of providing good roads and safe bridges to
make the health facilities accessible to the rural dwellers cannot be
over-emphasized. The recent collapse of the close to 50 (fifty years) old
bridge over Urasi River in Amaruru (in Orlu/Orsu/Oru East Federal Constituency
of Imo State), which links Orsu LGA of Imo State and Nnewi South LGA of Anambra
State has adversely affected access to health care services by Nigerians on
both divides of the collapsed bridge. Voters and Nigerians on either side are
no longer able to move to health facilities for care. This bridge constitutes a
national/state emergency in order for our country to achieve the SDGs
especially SDG3 as the fear of another cholera epidemic looms so large from the
disaster, as well as grounded economic activities of Nigerian’s who daily ply
the Orlu-Ihioma-Amaruru-Ezinifite-Nnewi Road with the said bridge as the only
link between the two States.
c. Compulsory
Social Health Insurance Programme: Nigeria must START
INVESTING IN CITIZENS WELFARE (emphasis
mine) by providing free Health Care for all the vulnerable members of the
Nigerian Population, while encouraging Civil Society Organizations (CSOs)
should to perform their monitoring and supportive activities in all health
facilities and their operations. We should invest in the health and health
education for our rural dwellers thereby freeing their time, savings and energy
to be deployed into economic ventures that will further improve national
productivity for both national needs and export, thereby increasing the country’s
foreign exchange earnings, strengthening the naira and increase citizens
purchasing power.
d. Promote
Healthcare Investments and Universal Health Coverage (UHC):
The National health Act provides for 1%
of Nigeria’s consolidated revenue to be deployed to health in addition to the
routine budget. While one appreciates the National Assembly for this and for
including this provision – even though late - in the 2018 National budget, it
is still a sad commentary that Nigeria, which rolled out her resources to host
African Union in 2001 to approve the allocation of a minimum of 15% of national
budget to Health, has hitherto FAILED to comply with that agreement to which we
appended our Presidential signature. We
affirm that investments in health have a lot of multi-sectoral benefits for
everybody. To this end, we urge our country to:
i.
promote massive Health Education to
citizenry especially to visit facilities for routine checks before ill-health
occurs;
ii.
promote PHC more vigorously as the pivot
of our health systems;
iii.
provide essential drugs and health
commodities;
iv.
ensure every child presented in a health
facility receives complete due immunization before leaving hospital;
v.
establish and encourage big companies to
establish Community Health Insurance Scheme (CHIS) for cluster of communities;
e.g. Shell established one in Rumuobiokani, Port Harcourt in 2007 and it’s
amazing that patients come from as far as Aba and Owerri to benefit from the
scheme. This has reduced their annual family health expenditure to as low as
N15, 000.00 (Fifteen Thousand naira only) including child delivery; while
caesarian section under the scheme costs as low as N60, 000.00 (Sixty Thousand
naira only). OTHER companies should be encouraged to do similar things in the
communities as part of their Corporate Social Responsibility (CSR);
vi.
institutionalize Palliative Care in our
rural communities;
vii.
provide functioning Health facilities in
all political wards in Nigeria; and
viii.
provide at least one functional
model PHC (not just buildings) in every electoral ward with equipment for
ultrasound, basic modern laboratory and diagnostic services, essential drugs
supply, storage facilities;
ix.
emphasis goog health worker
attitude and insist that those with persistent bad/poor attitude to their work
are penalized; and
x.
promote periodic mobile health
clinics that travel through communities as complementary to routine
facility-based services
e. Policies
have not failed, people have: There is a general
belief that Nigeria’s greatest challenges in achieving better welfare for her
rural (and urban) population is not the absence of laws that provide for these.
We agree so far. We therefore urge that we give life to all our existing laws
regarding health care services and development of rural communities. We urge
Federal, States and Local governments and all stakeholders to:
i.
embrace and implement all existing
policies on Health in Nigeria;
ii.
support health care professionals
to play their roles in UHC
iii.
provide enough and
appropriately-skilled staff in all health facilities
iv.
engage for each PHC a general
physician and a resident midwife attending to its patients, and encouraged to
make necessary referrals;
v.
harvest and secure data and
information for all persons accessing services in our health facilities using
the National Health Information Management corridor; and
vi.
increase efforts on population
control and the best health for the living.
V. CLOSING COMMENTS
We want to close our contemporary comment and
contribution on this Bill via this memorandum, by REQUESTING that every ELECTED
OFFICER OR POLITICAL APPOINTEE at the levels of The Presidency, National
Assembly, State Governments, Federal and State Executive Councils, Senior
Officials of all Ministries, Departments and Agencies, ADOPT one rural Primary
Health Centre as the first place to seek for care when sick or seeking
healthcare for self, families, friends and dependents. Short of requesting that
these our greater compatriots should adopt one PHC in their respective
constituencies and own/support its operational activities by providing
commodities/drugs, equipment, staff salaries, other operational costs; we
firmly believe that their patronage of such facilities will increase the
profile, recognition and patronage of such facilities by health professionals,
patients and other stakeholders.
So help us God!
