Creative Healthcare Delivery

Anambra State, southeast of Nigeria is changing the face of healthcare delivery in the country through government-mission partnership and hub-spokes arrangement.

Unknown to the public, Anambra State, southeast of the country, has been busy tiptoeing into a revolution silent but strong enough to alter the repulsive face of Nigeria’s troubled healthcare system. When Willie Obiano, Governor of the state therefore gave out the sum of N254.5 million as intervention fund to faith-based healthcare institutions on Monday, August 21, at the Prof. Dora Akunyili Women Development Centre, Awka, he was neither influenced by political considerations nor religious sentiments. It was also neither stray nor incidental. It was a further step towards sustaining the loom- ing revolution and a creative nimble move to reconstruct the matrix of Nigeria’s weak healthcare industry and make a clear difference in service delivery.

The governor said the deft act was a demonstration of his administration’s commitment to improving healthcare delivery and providing affordable and accessible service across the state. He added that the initiative was to support the missions as critical partners in driving the renaissance in the state’s healthcare delivery effort.

Obiano said the scheme was targeted at strengthening healthcare delivery in the state from the perspectives of provision of infrastructure, ensuring the comfort of patients (the clients of the hospitals) and training and retraining health workers. He inaugurated the state’s Diagnostic Centre worth N400 million in 2016 and supported the institutions with N200 million during the year. So what was witnessed at the latest outing of the governor was to build momentum on the unfolding revolution.

He stated at the occasion: “We have divided what we are doing into two categories. The first category is what we call the enablers; enablers because they are not an end in themselves but a means to an end. That’s why security is number one enabler. On the list of enablers are what we are doing in education, in health which is the reason we are here today, in the environment, the youths entrepreneurship in tourism and what have you. We have about twelve of the enablers; but in economics, the enablers alone will not help you grow your GDP faster. What will help you do that are what we have in my four pillars: Agriculture, Trade and Commerce, Oil and Gas and Industrialisation. These are the core areas that are generating the greater percentage of the work.

“On health, when I came in and assumed office as governor, I told myself that for me to be considered successful in the health area, 3 things must happen. One is infrastructure; infrastructure does not include this building but it includes the medical equipment and others. What we are doing now in the 93 health centres across the state is to equip them and that’s why we have this special Innoson made Tricycle Keke Ambulance and that is made available to the 543 primary health centers in Anambra State. Like the commissioner told you, we were visiting some locations and somebody was wheeled to the primary health care in a wheel bar- row and I was very touched.”

The governor described by his Special Adviser on Agriculture, Tourism, Training, Methodology and State Emergency, Amaechi Okwuosa, as the most mission-friendly governor in Nigeria has also requested all other hospitals promoted by missions but not included in this year’s programme to submit their details for inclusion in the 2018 budget.

While distributing the cheques, number of hospitals promoted by the missions and denominations as the law gazettes in the 2017 budget as well as capacities were factored in. The Pentecostal denomination with only one hospital in the state, for instance, received the sum of N15 million, while the Anglicans with more than 15 facilities got N84million. The Roman Catholic hospitals that were much more also received N159.5 million.

While Nigeria loses so much of its scarce foreign exchange resources annually through hurtful medical tourism to such destinations as India, Saudi Arabia, UK and Germany, among others, the ministry of health in the state has tiptoed into empow- ering the healthcare system and lifting service delivery in the industry to a new height with the introduction of specially designed six-feet tricycles as ambulances, especially in the primary segment of the sector.

Health Commissioner, Joe Akabuike, a consultant Obstetrician and Gynaecologist told CherryAfrica that healthcare in the state has received fresh fillip following total reforms in the sector that have guaranteed coordination and greater efficiency, dovetailing into the introduction of Universal Health Insurance Scheme for which the sum of N200 million has already been paid. Primary healthcare system has also been strengthened and the State Integrated Emergency Management System set up. It was learnt that these measures proved useful during the infamy of the Ozubulu church attack. Dr. Akabuike also disclosed that the governor had released the sum of N747 million so far to mission-owned hospitals in the state since the inception of his administration.

He told CherryAfrica: “We have understudied them and found out that they are very productive and remember that most of these hospials came through the missionaries and then management were better. Same thing happened in this State. All the schools were given back to them because they found out that they were managing them very well. But what government is doing now is not to dump them; we carry them along because our interest is for the good of our people. So irrespective of from which angle that is coming, it’s a kind of mission-government partnership. So we are partnering with them. So in this part of the world, what we need is to put things on the ground for them and giving them hospitals fully equipped, and the necessary human resources. That’s what is needed here and that is exactly what we are doing.

“Unfortunately, because we have some kind of recession that actually started with this administration, we are able to manage it, and if you see from my presentation you find out that we are entrenching the ‘come home’ philosophy. We don’t see any reason why we should be travelling to India and US for medical treatment and if you go there almost half of the people there are Nigerians so what we are trying to do is to reverse this trend by making sure that you see that you have CT Scan, you have MRI, you have more sophisticated equipment in place here.

So what we are doing is to reverse such trend be- cause we know we have the capacity. “In this place, our major target is making sure that we provide the necessary infrastructure and human resources aimed at providing a standard healthcare for our people and this we are able to do; and I can tell you that the problem of health in this part of the world must have actually been solved above 80 per cent and if you are used to our people you find out that about 80 per cent of those people that travel outside Nigeria for health are mainly Igbos. They travel anywhere. If you go to Indian embassy you must see at least 50 per cent of the people there are Igbos; so since we know that on average our per capita income is above 50 per cent, there is barely any state in Nigeria that has the standard of living we have in this part of the world because our people are very industrious. They don’t believe in anybody feeding them; if you see somebody being a wheel barrow pusher, be- fore you know it, the man becomes a multi- millionaire from there; they have such enterprising spirit, and because of that, we find out that the kind of assistance we need for them is to provide the best for them and a good playing ground and they play the football very well.

“So that’s actually what we have done. In my presentation, we were trying to tackle it from the primary healthcare level to make sure that people in the Riverine areas have basic units of healthcare so that if that one is for everybody, they will come to the secondary level, at least those people in the primary can refer to the secondary, and the tertiary level where we talked about the medical tourism, so that if you are able to handle these three arms of health, then one would have been what you are saying now, we are on it.”

As part of the outcomes of the intervention by the government, St Joseph’s Hospital Adazi now has additional capacity to respond to challenges in the high-end of the health- care value chain. Led by Prof. Joe Nwilo with his team of experts from other parts of the world including India, CherryAfrica learnt, the hospital has so far performed 30 open heart operations, recording a praiseworthy 100 per cent success rate. Dr. Akabuike likens the team’s feat on open heart surgery to the ease of malaria treatment.

Doctors Without Borders are also partnering with the state to establish and efficiently operate a quality Trauma Centre in the state. In addition, the state has established a Traditional Medical Council aimed to regulate and streamline the activities of unorthodox medical practitioners as well as give more options to people with peculiar medical needs and income streams. Dr. Akabuike said: “For instance that Joe Nwilo centre where we do cardiac surgery, was renovated by the government, which also paid for the specialist surgeons that are coming from Atlanta and they are doing open heart surgery like they are treating malaria. So this is the essence and the idea be- hind partnering with them because we believe in what they are doing, we believe in their productivity, we believe in their accountability, we believe in the quality of health care they are giving and we believe that it will be beneficial to all the people in this State and beyond.”

Asides endeavours in the medical field, Obiano’s intervention also has some knock-on effect that demonstrates economic empowerment.

Through a deliberate policy stroke, the state government chose not to patronise the brands of tricycle that are imported into the country. Instead of these brands, it has given further impetus to Innoson Vehicle Manufacturers, an indigenous auto manufacturing company, which has been engaged to design and produce a special brand of tricycle models for use as ambulance in rural communities and remote areas that may be difficult to access in the course of healthcare delivery. While that singular initiative has the capacity to bulge the company’s production possibility frontiers, it also creates employment opportunities and could translate into massive ancillary activities in the state’s economic chain far beyond healthcare delivery. There would sure be a need for acquisition of new skills both formal and informal, for the maintenance and driving of the ambulance. The entire multiplier effect would not only bolster the realisation of Nigeria’s industrialisation objective, it would also dilate the growth paths of the country’s economy.

For instance, Dr Akabuike told CherryAfrica that the beauty of the whole scheme is that it has been seamlessly strewn for effectiveness. He said: “It is. We got this from the internet.

I showed it to the governor. He told me that Innoson could do it; so we went and met him and he built it.” Asides this, the challenge thrown up by the latest innovation would mean fresh opportunities to Innoson Group as other states and regions in Nigeria and Africa may opt for the idea too.

The commissioner adds: “It is an innovation in hospital management. You know because of the challenges in the economy of this country and then challenges in also making use of what you have, we came up with that innovation. If you see a model of the Keke Ambulance, it is specially made, tailor-made because it is 6 feet. So somebody can lie on it.

There’s a seat where the nurse can seat, it has oxygen there; it has where you can hang drip and you just have the Keke driver that drives it. The essence is to make sure that goes round to everybody in the rural area. Second, it acts as a form of what we are doing, which is a hub and spoke arrangement. The hub is the general hospital; the spokes are the primary healthcare centres. From the spokes they come to the Centre that is the hub. So it is that Keke ambulance that will now transport patients from those rural health centres to the general hospital. At general hospital levels, we now have ambulances, big vehicle ambulances because they have the capacity.

For instance, if we have the health post the one I told you earlier and they have about 2 nurses, we can leave that Keke ambulance for you. Somebody is delivering and the person is dying, you start the thing and you put the person and you just rush because at times most of these things happen late in the night, say by 1 a.m; somebody is delivering and starts bleeding. In some places they will trek up to 5 kilometres looking for vehicles and they will not get anything; they will just tell you that this man came back from Lagos so they will go there and start to beg, sir please come and help, and by the time they finish the person is gone. Can you imagine a situation whereby you have the Keke ambulance and the driver of that ambulance is the security man? That is what they call task sharing.

You know why it has to be the security man? Because he doesn’t go, he is readily available so that if you have two security men, this one covering day this one covering night, they are also the drivers. So if they have problem they can call them and say this person is dying. They have their cell phones, they will just drive and pick the person to the hospital or if they are managing the person and the situation is getting worse they will just drive the person to the nearby general hospital.”

The Keke Ambulance initiative in Anambra state is akin to the initiative in Rwanda, where Drones are used in healthcare delivery to remote parts of the country.

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