Program to Build Leadership and Accountability in Nigeria's Health System: Our Impact

 {Photo credit: MSH staff}Baby Rosemary and her parents in Onuk Essien Udim Local Government Area, Akwa Ibom State, Nigeria.Photo credit: MSH staff

Chief Victor Joseph Ntuen is village head of Onuk, Ukana clan in Essien Udim Local Government Area (LGA) in Akwa Ibom State, Nigeria. He and his wife Emem have five children. Their youngest, 11-month-old Rosemary, fell seriously ill in January. She constantly vomited and had diarrhea for over one week. Baby Rosemary was diagnosed with cholera. Chief Ntuen was devastated at the thought of losing his baby girl to the cholera outbreak ravaging the community. But, they had no money to take Rosemary to the hospital for treatment. He and Emem had just paid their older children’s school fees.

 {Photo: MSH staff}Nse (on right) with CBHI Board of Trustees Chairman, June 2015Photo: MSH staff

Nse Usoro Odo is a 56-year-old farmer who lives with his wife, a small-scale trader, and their children in Ikot Udo Idem community in Akwa Ibom State, Nigeria. He is also the village town crier and a member of the Village Development Committee (VDC). Members of the VDC are responsible for conveying knowledge and information to community members. Combined earnings for Odo and his wife are around 700 naira or N700 (less than $3.50 USD) per day.

{Photo Credit: Gwenn Dubourthoumieu}Photo Credit: Gwenn Dubourthoumieu

In Nigeria in 2014, MSH's PLAN-Health program assisted two state governments in launching the first community-based health insurance plan to cover small-scale business owners, farmers, traders, artisans, and others. PLAN-Health is funded by PEPFAR through USAID and supports Nigeria's goal of increasing coverage from 10 to 30 percent by 2015.

 {Photo credit: Samuel Edet/MSH} A large crowd observes the festivities.Photo credit: Samuel Edet/MSH

There is no way we can achieve the presidential mandate of 30 percent health coverage by 2015 without tapping into Nigeria’s informal sector. Community-Based Health Insurance (CBHI) is therefore a veritable tool to ensure wider coverage, increased ownership, and an entrenched culture of health insurance among the Nigerian public. 

{Photo credit: Jessica Charles/MSH, Nigeria.}Photo credit: Jessica Charles/MSH, Nigeria.

Gender-related stereotypes, gender profiling, and inequalities between men and women reduce the impact of public health programs. In Nigeria, for example, many women are excluded from making decisions related to their families’ health and from accessing health services in their communities. These exclusions are due to patriarchal norms, often exacerbated by purdah, a religious and social practice that requires women to cover most parts of their bodies and avoid areas frequented by men.

 {Photo by Akintunde Akinleye, courtesy of Photoshare}Nigerian woman.Photo by Akintunde Akinleye, courtesy of Photoshare

Management Sciences for Health’s Nigeria Program to build Leadership and Accountability in Nigeria's Health System (PLAN-Health) supported the Federal Capital Territory (FCT) Health and Human Services Secretariat of the Health Planning, Research and Statistics department to develop an eHealth policy. The eHealth policy is a set of principles and actions to guide implementation of healthcare practices supported by electronic processes and communication, including the use of health applications on mobile phones.

 {Photo credit: MSH Nigeria.}APYIN staff.Photo credit: MSH Nigeria.

The Association for Positive Youth Living with HIV/AIDS in Nigeria (APYIN) promotes sexual and reproductive health rights of young people in eight Nigerian states. However, the project was experiencing some challenges with streamlining activities, recordkeeping, and assuring the quality of services. As a result, APYIN was underperforming and at risk of losing donor funding.

 {Photo credit: Dr. Saddiq Abdulrahman}Dr. Tali Butkap addresses community members during a sensitization meeting in Waru.Photo credit: Dr. Saddiq Abdulrahman

Waru is an underserved and hard-to-reach indigenous community in the Federal Capital Territory (FCT) of Nigeria. Until recently, this community did not have a safe waste disposal system and the majority of homes did not have toilets. Residents often dumped their garbage in open fields and defecated in bushes. This haphazard disposal of human waste and garbage caused Waru’s water sources and environment to become contaminated and, in turn, many residents suffered from diarrhea, cholera, intestinal worms, malaria, and typhoid.

Dr. Jide Idris, Lagos State Commissioner for Health (middle), Dr. Barry Smith, MSH Nigeria Country Director (right), and Permanent Secretary, Lagos State Ministry of Health during an interactive session with participants at the ministry headquarters. {Photo credit: MSH.}Photo credit: MSH.

Many Nigerians are recognizing that community-based health insurance (CBHI) can increase access to healthcare services. Since 2008, Nigeria’s Lagos State Ministry of Health has been piloting CBHI schemes in Ikosi-Isheri and Ibeju-Lekki local government areas. Enrollment in the CBHI has grown, with more than 16,000 enrollees in Ikosi-Isheri alone. Out-of-pocket healthcare spending by low-income earners has been reduced. According to Lagos State Commissioner for Health Dr. Jide Idris, the pilot communities are responding positively, despite challenges in implementation.

Clients relaxing in the Children's Room. {Photo credit: MSH.}Photo credit: MSH.

A children’s playroom at the Children’s Specialist Hospital in Ilorin, Nigeria, is having tremendous success at attracting HIV+ mothers and children, increasing the numbers of adult and pediatric patients enrolled into care and treatment. The playroom is the result of a collaborative partnership between the USAID-funded Prevention Organizational Systems AIDS Care and Treatment project (ProACT), a project led by Management Sciences for Health; the Kwara State Government of Nigeria; and local non-governmental organization the Well-Being Foundation.

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