Strengthening Nigeria’s Health Services: A Grassroots Example

By Chukwumuanya Igboekwu

Nigeria, Africa’s biggest economy, is a country of contradictions; opulence exists alongside extreme poverty; towering new buildings stand next to tin-roofed single homes; and democracy competes with widespread corruption. As a medical professional, nowhere is this contradiction as vivid as it is in our healthcare system, where people in rural regions have been virtually excluded from health services that are readily available to those in urban centers.  

As a young medical student, I believed access to health to be a fundamental right.  When I graduated in 2002, I was sent to Mashegu district in Niger State, Northern Nigeria to complete my National Youth Service at a government-run rural hospital. I wondered what need they would have for an easterner there. It didn’t take long for me to find out the answer.

Northern Nigeria lags far behind its southern and eastern counterparts by all development indicators, particularly health. The poverty rate in rural Mashegu, where I was based, is over 70 percent, making it impossible for most families to afford health expenses. With a maternal mortality ratio of 774 per 100,000 births and infant mortality rate that is worse than the already poor national average of 191 per 1000, women and children are the most vulnerable groups in this region.

Our health system was failing the most vulnerable people.  For most of my tenure as a National Youth Service volunteer, I was the only doctor serving a population of 290,000 at the time. Everyday, I would see patients who traveled miles to get to the clinic. Each day, I would diagnose illnesses and prescribe medicine that they couldn’t afford. I would finish my day knowing there were even more people who couldn’t come to the health center because they lived too far. We desperately needed to figure out how to 1) reach people that cannot access health services and 2) make sure they can secure the medicines they need. A group of doctors and I founded Physicians for Social Justice (PSJ) in 2004 to tackle these challenges.

PSJ’s programs are focused entirely on supporting poor rural communities in northern Nigeria to address the full spectrum of health and social obstacles that impede their access to healthcare, and lead to death of women and children; from weak health systems to poor community awareness about health issues. We strive to help communities realize health related Millennium Development Goals by providing essential health services, making childbirth safer, increasing children’s access to immunization, and providing care and support to PLWHAs, AIDS orphans, and other vulnerable children. We promote health-seeking behaviors and develop the capacity of communities to improve the well-being of their women and children through advocacy. We are the only health service provider in the region we work.

To reach remote communities that can’t access the government hospital, we created a mobile health clinic that travels thousands of miles each year to provide basic health care. To help people pay for essential medicine, we developed an insurance scheme that engaged the state government, the local government, a German funding agency, and the community. Each party contributed to this insurance pool with community members paying one dollar a month to receive health care for five years; an additional dollar was paid for each child over the age of 5.  This arrangement enabled thousands of people to benefit from reliable and ongoing health care, making medicine affordable for them. With preventive care and treatment, we were able to save lives.

Ultimately, health care is the government’s responsibility, but in its failure, no one is better suited to fill the gap than local organizations that have the technical, cultural, and personal knowledge and investments needed for effectiveness. Over the years, we have built deep relationships with the villages we serve; they know we are here to stay.  We have been nimble, flexible, and responsive to their needs. Our work as an organization, is however, only as successful as their engagement. They must ultimately demand their right to health and hold their leaders accountable. To that end, PSJ spends a significant part of its work on community organizing, teaching villagers about their rights, the health budgets of their districts, and effective advocacy strategies. They’ve used these skills to push for improved sanitation facilities and qualified personnel in health centers.

In fact, Mashegu’s government-run health centers today have 24 staff, including midwives and outreach workers, a far improvement from when I was the only medical professional, but long ways from what is needed to truly move the needle on national health indicators.  Transforming a country’s health care system will take time. It starts with the small steps of dedicated people who demand more from their communities and leaders. Organizations like Physicians for social justice are here to facilitate that process. This, after all, is our problem, our country.