Nigeria’s best Option for Universal Health Access
Even though Osunbunmi Ayo is a medical laboratory scientist, he had his eyes on politics and like any other aspiring Nigerian politician, he needed to do something important and noteworthy for the communities he intended to represent at the House of Assembly when he eventually wins the forthcoming elections so he decided to do something he believed was urgently needed in the communities within his local government – provision of free healthcare services.
He said he regularly takes several medical teams to Faleke village in Ibadan, Ikereku village located in Akinleye local government and several other communities in Oyo state. He identified a vacuum in the primary healthcare system in the state and the large turnouts he recorded at each medical outreach confirm that more people at the rural level in southwest Nigeria long for access to healthcare service.
The situation is the same at the Primary Healthcare Center located in Ehor, Edo state. The community served by this center often have to wait for non-governmental organizations such as Pro-Health International to bring their team of health professionals to provide various kinds of healthcare services for the local community. Chris Alagboso is one of the volunteers that had visited several primary healthcare centers in various parts of Nigeria and according to him, the situation may not be the same but are extensively similar.
“The primary health centers are largely non-functional, and they only spend money on them when something is about to happen. Even where the primary healthcare centers are working, they are not really providing the services they should be providing. There is a dire need for provision of medical services at the primary level, the vacuum needs to be filled,” he said.
Past and present Nigerian governments at the federal, state and local levels had promised to provide comprehensive primary healthcare service to its citizens although this has not been extensively successful. The successes recorded by a government may not be sustained by a new government and the local communities that had been given a taste of what primary healthcare service should be may have to readjust to experiences of previous years of abandonment if the new government decides to focus on something else apart from primary healthcare – say education.
Villages and rural communities across Nigeria are dotted with buildings that ought to be primary healthcare centers but are at various degrees of dilapidation. For the functioning ones, those in charge of them often complain of neglect, insufficient drug stock, poor electricity supply, low manpower among others. Even though most of the services provided by the primary healthcare centers in Nigeria are free, the local communities often prefer to use privately owned health facilities instead, and at a fee.
“Most of the times when you visit the government-owned primary center, there will be nobody there or they will say there is no drug. They don’t have generator and it is not a very good place to go to when you need to quickly take someone to the hospital to access emergency services. Just last week, a pregnant woman had to deliver on the roadside because they didn’t have light at the clinic; they had to make use of the streetlight. Even the workers are not happy to work at the health center,” said Mr. Amao Adekunle who resides in Eggua village in Ogun state.
“Even though it is possible for pregnant women to deliver at the health post,” she said deliveries are done at the primary health center which has more equipment and bigger facilities to handle deliveries and other healthcare activities. While the health posts perform functions such as vaccination, the health center in addition to births, also handle cases that are beyond the capacities of the health posts and one of such is the prevention of mother-to-child transmission of HIV.
“Everyone in the community is accounted for,” said Hailu. “I coordinate those that we call health soldiers whose functions include taking care of specific members of the community that are within their areas of coverage.”
At the home of one of the health soldiers, she said she volunteered for the position because of the prestige that comes with volunteering to help her community. According to her, every year, they organize an event to honor them in addition to a certificate which she proudly displayed in her living room.
Due to the effectiveness of the referral system, Hailu said everyone is accounted for in Ethiopia and interactions at various levels made it possible for the country to put an end to home and unattended births.
“The government mandated that all births must be done at health centers,” she said. And the mandate was backed with actions. In several communities, a mothers’ waiting area is set up directly opposite Keyit Health Center, for pregnant women who are expected to give birth within few days at the health center.
While effectiveness of the referral system is impressive, the road to its current state reportedly started in 2004 when the Ethiopian government decided on its own to transform its healthcare system with the engagement of health workers such as Hailu to make healthcare accessible to everyone in the country.
“The government approached several funding agencies back then for support but got none. It then decided to use its own money to transform the health sector. When it completed the first phase and donors began to see it was working, then everyone moved in and began to lend support. Now it has grown to become one of the highly effective healthcare models in Africa that ensures that healthcare is accessible to everyone,” said Dr. Ayo Ajayi, Africa team head at the Bill & Melinda Gates Foundation.
Ethiopia has also been able to leverage on the healthcare model to achieve impressive results in healthcare. Speaking in Addis Ababa at the official opening of the Africa regional headquarters of the Bill & Melinda Gates Foundation, the first lady of Ethiopia, Roman Tesfaye Abneh, said the transformation of the healthcare system in Ethiopia has made it possible for the country to meet almost all the millennium development goals (MDGs).
Investigations revealed that the Nigerian government through the office of Vice President had already inquired about the Ethiopian healthcare model but did not make any official confirmation on plans to implement the model in Nigeria.
“Ethiopia is also a very big country and has the second highest population in Africa after Nigeria. Nigeria has more resources than Ethiopia and there are many donors in different parts of the world that would be willing to help Nigeria if it finally decides to copy the model in Ethiopia. But we cannot push the Nigerian government to act, it has to decide on its own that it wants to do it then we can offer support,” Dr. Ajayi concluded.