A mango in the backyard that cannot be plucked: FCT indigenes face glaring health inequities

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Editor’s Note: In this week’s Thought Leadership blog, Nigeria Health Watch Journalist Chibuike Alagboso spotlights health inequities faced by Abuja’s indigenous peoples. They live in one of Africa’s fastest growing cities but lack access to healthcare and social amenities. Nigeria Health Watch’s Director of Policy and Advocacy, Dr Ifeanyi M. Nsofor, conceived the “Health Equity for FCT Indigenes” project as a 2019 Fellow of the Atlantic Fellowship for Health Equity at The George Washington University, USA, and leads the team working on the project. Follow the hashtag #HealthEquity4FCTIndigenes on Twitter to stay up to date with the conversation.

A world where social services are not equally distributed breeds inequity. This is the reality for many groups of Nigerians in different sectors, whether it be education, health, or access to finance, and is usually at the heart of advocacy efforts. But for the original inhabitants of the Federal Capital Territory (FCT), inequity from lack of access to basic amenities is their daily reality.

Most FCT indigene groups had to give up their lands when the nation’s capital was moved from Lagos to Abuja in 1991 by then head of state General Ibrahim Badamasi Babangida. Nearly three decades later, they are still being asked by the government to be patient with the provision of basic infrastructure. They are unable to enjoy some social infrastructure and face health inequities.

Most people living in Abuja are unaware of its history. An online poll conducted by Dr Ifeanyi Nsofor of Nigeria Health Watch showed that 50% out of 175 respondents believed Abuja originally belonged to indigenous people. Thirty percent didn’t agree the city ever belonged to any original inhabitants, 10% didn’t know while 7% did not care.

Image credit: Nigeria Health Watch

Inequity in access to water, a detriment to health
The United Nations Children’s Fund (UNICEF) commissioned a paper in 2016 to provide evidence on the impact of water, sanitation and hygiene (WASH) on key health and social outcomes to support their WASH strategy for 2016–2030.

The evidence paper assessed ten areas where WASH can have a significant impact. They are: Nutrition, maternal and new-born health, oral vaccine performance, Neglected Tropical Diseases (NTDs), diarrhoea, complementary food hygiene, female psychosocial stress, violence, menstrual hygiene management, and school attendance.

Despite the recognised impact of WASH on individual and public health, access to clean water in most rural communities in Nigeria is still problematic. Water Aid Nigeria estimates that 60 million Nigerians don’t have access to clean water and 60 thousand Nigerian children die before they start school from diseases linked to dirty water, poor sanitation and hygiene.

The pool where Sauka community members fetch water and boil before use. Photo credit: Nigeria Health Watch

Sauka is one of the communities in Waru District in Abuja Municipal Area Council of the FCT. With a population of 2158 people, Sauka’s residents are predominantly from the Gbaygi tribe, mostly farmers and traders. Chief Bala Zaki, traditionally called the Esu, oversees affairs of the community. While Sauka has seen some development since the relocation of the Federal Capital, many social services are still unavailable. The only source of clean water for the community is a borehole built by the Rotary Club of Abuja Metro. Recently the generator that powers the pumping machine went bad, so they have resorted to fetching water from a pool that runs under a newly constructed bridge close to the community. They must fetch the water early before cows wade through the pool. “We just fetch the water like that, boil it and drink it. We are contributing money to get a new generator but it’s not complete,” Chief Zaki said.

Children in the community play in the dirty water and this exposes them to various diseases. An example is the 15-year old brother of Rejoice Luka who has been urinating blood since 2016, a likely case of schistosomiasis, a common NTD. Rejoice took him to a health centre in a nearby community but couldn’t pay the fee of N10,000. His illness could have been prevented if the community had access to safe drinking water.

Image credit: Nigeria Health Watch

Efficient primary health care: A must for improved maternal health
With so many competing national interests, access to quality healthcare for every Nigerian is still a struggle for government at various levels. The impact of this is felt most by rural, hard to reach communities. Despite the availability of functional health facilities close to indigenous communities in the FCT, many cannot afford their services, and do not have access to health insurance. As a result, stories of preventable deaths, especially from pregnancy related complications, are common in these communities. 

One of the community women, Jummai Amos, spoke of how she lost her sister (Martha) during childbirth. Jummai is a deputy to the Sauka Community Women Leader. She said Martha didn’t visit any hospital for antenatal care because her partner could not afford to pay. When complications set in during delivery, the doctor in the private facility they visited in Kabussa, about 40mins from their village, referred them to another hospital in Lugbe, an hour from Kabussa. They were referred because the delivery required surgery he couldn’t perform as the baby’s head had already come out. Sadly, Martha and her baby died before reaching the hospital in Lugbe.

The Esu of Sauka Community, Chief Bala Zaki share the experiences of his community since its existence. Photo credit: Nigeria Health Watch

The women leader of Sauka, Laide Amos, said a primary health centre in their community will help alleviate some of their suffering. She recounted how, three years ago, a Catholic Church in the community trained some women to handle simple deliveries and to always refer when there are danger signs. She wants the program to be resuscitated and more women in the community equipped with basic skills to handle uncomplicated deliveries.

Chief Zaki said he has reported these challenges to the councillor in-charge of his community, who promised to inform the Abuja Municipal Area Council (AMAC) chairman. They are yet to see any action towards addressing these challenges.

Opportunities for impact within grasp for FCT’s incoming leaders
A Chinese saying that, “The best time to plant a tree was 20 years ago and the second-best time is now,” holds true for Nigeria today. With the 43 ministerial nominees from President Buhari cleared by the Senate and heads of Senate committees announced, this is a fresh opportunity for the FCT government to provide basic amenities such as water and healthcare services for the original inhabitants of the FCT. 

The incoming FCT minister should work with the six area councils to identify challenges indigenous communities face, and work with communities to address them. The indigenous communities must also hold their area council leaders to account, to judiciously use the revenues from taxes and the monthly Federation Accounts Allocation Committee, and to ensure they are included in development plans for the FCT.

Students of the nearby LEA Primary Sauka said they want the government to give them water. They wake up to fetch water by 5 am before school resumes by 7:30 am. Photo credit: Nigeria Health Watch

Nigeria’s new crop of leaders should also maximise the opportunity offered by the upcoming United Nations General Assembly (UNGA) starting on September 17th, to meaningfully engage and strengthen commitments with partners. They can leverage two important events during this meeting to bring these issues to the fore; First is the Sustainable Development Goals (SDGs) Summit on 24–25th September, and second, a high-level meeting on Universal Health Coverage on September 23rd, where leaders will gather to support affordable health for all.

Elevating Health Equity for FCT’s Indigenes
The Health Equity for FCT indigenes project was designed to bring attention to the challenges faced by Abuja’s indigene communities. Nigeria Health Watch’s Director of Policy and Advocacy, Dr Ifeanyi Nsofor, conceived the project as a Fellow of the 2019 Atlantic Fellowship for Health Equity at The George Washington University, USA. The project aims to bring these issues to the attention of non-governmental and community-based organisations already working in the FCT to adopt and address.

This is already yielding results as a tweet from Dr Nsofor after the visit to Sauka community led two organisations, Centre for Family Health Initiative and Vaccine Network for Disease Control, to partner with the FCT public health department to sensitise the community dwellers on the danger of using contaminated water and how best to treat water before use. They also have plans to curtail waterborne diseases and treat people affected. Martha’s story is also being featured under the #GivingBirthInNigeria project.

Non-governmental organisations working in the FCT collaborated with a government agency to address some of the health challenges identified in the Sauka. Photo source: @nighealthwatch

We all should be willing to advocate for health equity for FCT Indigenes. They have given up their home to make room for our nation’s capital. As a nation we must make sure they get the quality healthcare they, and all Nigerians, deserve.
 
Do you know of an indigenous community in the FCT that is in dire need of healthcare or other social amenities? Let us know! Use the hashtag #HealthEquity4FCTIndigenes

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