Nigeria’s healthcare investment is grossly inadequate, and resources are overstretched. A little over N356 billion is allocated for healthcare in the 2018 budget. With a population of 180 million, that is roughly N2000 per person for the whole year. The country also has 21 teaching hospitals, 20 federal medical centres and 13 specialty hospitals which are supported by several general hospitals mainly run by the states, and an estimated 30,000 primary healthcare centres (PHCs). Nigeria’s Minister of Health, Professor Isaac Adewole, in 2016 inaugurated a committee to ascertain the actual number of PHCs in the country.
The number of available facilities is clearly inadequate to cater for the healthcare of the largest population in Africa. Added to this, the available facilities have dire challenges, from insufficient medical equipment to inadequate manpower, which makes it hard for them to operate optimally. There is also the issue of out of pocket expenditure for healthcare, which plunges the poor and vulnerable into further poverty while seeking healthcare.
The resulting gaps in healthcare delivery means that other methods of providing care must be initiated, and medical outreach programmes are one of the non-conventional avenues through which Nigerians, especially those from low-income households, receive healthcare. Periodically, governmental and non-governmental organisations (NGOs), professional associations and corporate bodies carry out these outreach programmes in select locations across the country, providing life-changing treatment to people who may not have the financial means, or lack access to facilities.
While some medical outreaches target specific conditions, others provide diverse services. Shell Petroleum and Development Company’s ‘Health In Motion’ provides free testing, counselling and treatment of HIV/AIDS in rural communities across Niger Delta, and the Nigeria Medical Association’s (NMA) outreach to mark its 2018 Annual Scientific Meeting in Abuja provided care across different areas like obstetrics and gynaecology, cancer screening, dental care, ophthalmology as well as surgeries for hernia, hydroceles and others. A faith-based organisation, Pro-health international uses the services of volunteers across various health specialties to provide different healthcare services in rural and suburban areas through their medical missions.
From cataract to hernia, Nigerians all over the country live with health conditions that are treatable, yet they lack access to healthcare. Aside from money and access, ignorance also plays a big role in people’s decision not to seek medical attention when they are ill. This is one major reason why organisers of medical outreach programmes usually take time to sensitize people about various health conditions before delivering services. The Kebbi State government organised one such outreach in Kalgo LGA from Oct. 25th to November 9th 2018, that saw over 80,000 Kebbi residents receive healthcare services.
Kebbi state in Northwest Nigeria has an estimated population of over four million people. The state is mainly agrarian and is one of the largest rice producers in Nigeria. It also has the highest child mortality rate and second highest maternal mortality ratio in Nigeria. According to the state commissioner of health, Dr Umar Usman Kambaza, Kebbi has 225 primary health centres which cut across every ward. There are also several general hospitals, a Federal Medical Centre in Birnin-Kebbi, the state capital and the Kebbi State Medical Centre, Kalgo. The Kebbi State Medical Centre was the location of the fifth in a series of medical outreach programme organised by the state government with support from Moses Lake Medical Team, a Washington based NGO that provides medical care at outreaches all over the world.
For the Kalgo outreach programme, Moses Lake sent a team of professionals, a large contingent of drugs and other medical supplies. They collaborated with Pro Health International, Usman Danfodio University Teaching Hospital Sokoto, University College Hospital Ibadan and Federal Medical Centre Birnin – Kebbi. The Centre for Community and Rural Eye Care led by consultant ophthalmologist Dr. Fatima Kyari, operated on over 200 cataract patients in addition to eye treatments. Medicaid Cancer Foundation led by the wife of the state governor, Dr. Zainab Bagudu, provided breast and cervical cancer screening to women. In total over 250 medical doctors from different specialties – orthopaedics, general surgery, paediatrics, urology, and gynaecology – alongside over 150 nurses and other health workers, participated in this outreach, which targeted over 80,000 people from the 21 local government areas of the state, according to Dr. Aminu Haliru Bunza, the director of medical services in the state ministry of health. Most of the people were transported free of charge from their local governments to Kalgo. In order to create awareness for the exercise, local government chairmen were tasked to inform their constituents through community leaders some weeks before it commenced, and to take records of those with medical needs.
The medical team planned to attend to residents of two LGAs per day over the 15-day medical outreach programme. This technique however did not work and as the numbers kept increasing, pressure was put on the health workers and security agents whose duty it was to ensure orderliness. One beneficiary from Bunza local government area had been married for 20 years and her worry over her inability to conceive drove her to visit health centres in her community but these visits yielded no result. At the outreach programme, gynaecologists diagnosed her with fibroids and recommended a myomectomy. After the surgery, she recuperated in the female ward of the hospital. Another beneficiary was initially presenting with asthma and urinary issues was found to have benign Prostate Hyperplasia and had a successful surgery during the medical outreach programme.
Medical outreach programmes also provide opportunities for knowledge sharing and transfer. Dr. Umar Ahmed Farouk, a senior medical officer with the Kalgo Medical Centre, acknowledged that the diversity in the internal medical team is helping him improve his diagnostic and patient relation skills. Dr. Sa’ad Zubairu, a gynaecologist from Usman Danfodio University Teaching Hospital (UDUTH) Sokoto who has taken part in four of the five medical outreach programmes says he sees about 50 patients a day and also participates in gynaecologic surgeries which have enabled him to consult with his colleagues from other institutions on cases that have helped improve his capacity in the field. For Dr. Richard Omoyele Adenalo, a consultant orthopaedic surgeon from the University College Hospital (UCH) Ibadan, it is all about giving hope to people, and alleviating their suffering by providing them access to quality healthcare. Dr. Adenalo is participating in his third medical outreach programme in Kebbi state and has taken part in other outreach programmes in Lagos and Oyo state as a part of the Redeemed Christian Church of God (RCCG) Medical team. According to him, being in Kebbi has given him the opportunity to experience its culture first hand, and he will gladly come back for another outreach.
Child malnutrition is one of the many public health challenges affecting many states in Nigeria, and Kebbi state, despite its pedigree as one of the food-producing states in the country, has not escaped the scourge. According to the 2016-2017 Multiple Indicator Cluster Survey, 60.3% of children under the age of five in Kebbi state are stunted. The medical outreach programme revealed even more alarming statistics, as, according to Dr. Paula Carvajal of Moses Lake Medical Team, about 80% of under-five children who presented at the paediatric unit were suffering from malnutrition. This prompted the paediatric team to engage parents on the nutritional needs of their children during the consultation. The malnourished children were then referred to the Community-based Management of Acute Malnutrition (CMAM) centre in the hospital, where they were placed on Ready-to-Use Therapeutic Food (RUTF) before being referred to the available CMAM centres in their respective local governments for further follow-up.
The 5th Kebbi medical outreach programme has come and gone and has served many purposes. However, the state government must follow it up with policies that will address issues that were identified during the exercise, especially the prevalent child malnutrition that seems to be engulfing the state. Sustainable methods must be developed and deployed to prevent rather than to treat this health challenge, because children that are well-nourished will be immune to most of the diseases that lead to hospitalisation.
The National Health Policy on nutrition, which was adopted in 2016, highlighted critical steps that could be taken to prevent, and address malnutrition. This policy should be adopted at the state level, to ensure optimal nutrition in the first 1000 days. The policy includes nutritional care for adolescent and pregnant women, improving early initiation of breastfeeding and exclusive breastfeeding coverage, promote vitamin A supplementation for children 6-59 months and deworming for children 12-59, promote household and community sanitation and others.
Citizens must also be sensitised and encouraged to patronise the primary and secondary health facilities in the state, and not to wait for outreach programmes before seeking care for their medical conditions. The fact that up to 80,000 people could show up in a single, two-week medical outreach programme proves that a lot could be done to improve the healthcare system in Kebbi state. The state government must work towards instilling the trust of the people in the health facilities across the state. This could be done through improvement in all aspects of healthcare delivery, most especially primary healthcare strengthening.
The 225 primary healthcare centres in the state must be adequately equipped and staffed, and must be able to provide comprehensive services such as antenatal and postnatal, immunisation, sexual and reproductive health services. Primary healthcare workers could further carry out nutrition sensitisation exercises to homes and communities to inform parents about the nutritional needs of their children, and how they can use their available resources to provide the foods their children need.
An effective referral system between the PHCs and general hospitals should be established, such that primary healthcare workers can easily refer patients that require further treatment, and the secondary facilities must be strengthened both in equipment, drugs and manpower to be able to provide the speciality care they should be providing. Through these, the confidence of the people especially those at the rural areas in the health facilities will be elevated, and in return patronage at the facilities will increase, and the residents of Kebbi will have less need for medical outreach programmes.