When we recently called on you, our readers to send us your accounts of encounters with the health sector in our country, we were not quite sure what to expect. But the piece below took us completely by surprise. This beautifully written account of the primary health care system in Nigeria from the perspectives of government, private and corporate sponsors is an eye-opener to the challenges AND hopes of our health sector. Enjoy, send it round, and send in your own posts!
mongst workers and all employees are included in
consultations on what to do with profits (if any). This was undoubtedly one of the most impressive standalone systems I’d come across thus far; an unassuming rural clinic which employs principles of sustainability found in any global social enterprise: maintaining a low cost base, stakeholder engagement, maximising efficiency, innovation and transparency.
I saw that innovations with alternative energy can help with some of our infrastructure dilemmas we face, and the pooling of risk (such as in private health insurance schemes) can significantly reduce or eliminate the issue of cost. However, without the judicious management of resources these efforts will be essentially fruitless. My hope is that anyone thinking about healthcare in Nigeria approaches it comprehensively, and thinks not only about preventing and treating illness but also about infrastructure (and its maintenance), creating community stakeholders, health promotion, consumer attitudes and the quality of the care being provided and how it can be safeguarded, as well as the management of people and resources.
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead
Thanks for the trip ‘home’ to Eruwa. – Wonder if Dr Awojobi related his experiences prior to starting his clinic when he tried to run the State’s District Hospital in Eruwa with similar innovations and a belief that fees and imprest/petty cash should serve the clinic not the bureaucrats in Ibadan – anyway, those frustrations led to the development of his clinic – but he should be credited with trying to make the public system work first!
William Brieger
http://www.malariafreefuture.org/blog/
exhilarating, exciting and de javu————- the answer ‘Whole System change of failing health systems’ ——— as illustrated by the instructive three examples blogged by Dr Sunmonu that shows what can be done using local ingenuity. Wonderful.
Joseph Ana
Great perspective of our primary care system.
Who said we cant have a clinic like the one in Obio, PH if our heads have the will to do so? Like the writer said, it’s not so much of money but the right attitudes and policies in place.
The empty clinic in Dutse gives a picture of the attitude of the govt. staff. I am sure the clinic is empty cause the patients know they wont find any medic there not vice versa (the staff absent cause there were no patients).
I am in awe of Dr Awojobi!
This piece contributed by Femi reminds me of my experience while serving the country under the National Youth Service Scheme in Ondo State in 1999. I was posted to Baptist Hospital, Ile-Oluji in Ondo State and prior to my arrival, the over 30-bed structure didn’t do much to alleviate the health needs of the people. During my one-year service year, we worked together as a team and improved the services rendered. We commenced a Drug-Revolving Scheme and engaged some new staff also. There was support through donations from community-groups of the town in North America/Canada. Treatment of common communicable diseases, provision of antenatal , intra-partum and postnatal services, immunization were the core activities. We were able to recruit more staff and did commence medical outreaches to the Cocoa farms around the town. This was also possible despite the “Free Health Care” provided by the then Alliance for Democracy – led government.
However, 2 years after i left, services were down due to absence of committed human resources and materials.
The aspect of community insurance would have been the best for communities like this for sustainability.
Now, i have moved into public Health sector and do understand the numerous challenges facing the country.
The situation is not likely to be better except legislations are in place.
Where is the Health Bill?
I agree with the writer’s conclusion that what made the difference in the three facilities visited was not necessarily money, but the right attitude.
Which is why I disagree a lot with the endless agitation for improved pay when no one is pushing for inculcation of the right attitude in our health professionals.
Where were the service providers in Dutse PHC?
I worked in Obio for ten months. Working there was fun! When i resumed work in oct 09, i was shocked! well maintained facility, but very poor staffing! had to work as the only doctor there for about 4 months. Then came along the community health insurance scheme! Wonderful concept, implementation was a bit shaky at the onset. But with time, everything went on well! ANC registration soared to over 200 new bookings monthly. the delivery register too is getting filled up in no time. Six doctors run the shift at the hospital ensuring that the hospital is covered for 24hrs!nurses, midwives and CHEWs were posted en mass to the center.New equipments were brought in; A cardio-tocogram machine, ultrasound machine, we were also give a well equipped operating suit! It was ‘WOW’. All I’ll say is …Obio is one project down, 26 more to go!
By the way, its been upgraded to a cottage hospital!
Nice piece femi,i can say that i trained under dr Awojobi during my outsideposting in medical school at the university of Ibadan and graped the concept of appropraite technology,using available resources and technology to achieve standard result!!!!!
I am also part of the vision for the Obio health centre now Obio cottage Hospital from Inception uptil now.I was instrumental in drafting of the MOU and served as a the secretary in the Board of trustees.I was also previledge to be the originating CMD of the hospital at inception of the Community Health Insurance scheme.
The scheme is a public private pertnership initiative involving the state Govt,Local Govt,The Community,Private Organization(SPDC) and Health care International (a health Insurance Company) managing it.
It uses the concept of managed care which involves risk pooling of human and financial resources.
With Bulk purchase like a whole community, the cost for the scheme becomes highly subsidesed and the scope of disease covererge becomes very wide.Pre existing condition and chronic diseases and geriatrics can adequately be covered and not excluded.
Though the scheme is challenging but we are responding and not reacting to the challenge.Obio is actually a pilot from which we are deriving vital statistics and information for a more robust community insurance scheme for the entire nation of nigeria and Africa at large
This scheme can and will work in any community that is willing even without extensive subsidization from multinationals.
We hope to spread this concept across our nation as we have already stated now in rivers state(3 hospitals now!)We are willing to partner with any community or organization that calls on us for such!!!!!!!
Kunle Megbus