D4Access

Primary health care in Africa is rarely equipped to be the foundation of the healthcare system and is often bypassed by patients seeking hospital services. Reports by WHO indicates that the maternal mortality rate (MMR) in the Region is the highest in the world, averaging around 1000 deaths per 100.000 live births, with disparities among countries and between urban and rural areas. The high MMR, combined with low contraceptive prevalence rate of 13% and high fertility rate-estimated at 5.6 children per woman, increases the lifetime risk of maternal death-estimated at 1:14.

Nigeria has one of the most underdeveloped Primary Health Care system in the world. The available Primary Health Care facilities are not enough and worse still, only 20% of the available facilities are fully functional, the remaining 80% lacks the infrastructures to provide essential primary healthcare services that meet the needs of the people. They are confronted with series of problems including; poor staffing, poor distribution of health workers, poor quality of health care services, poor condition of infrastructure and lack of supply of essential drugs. With the outbreak of COVID 19 in 2020, the primary health care system is getting worse by the day. Already, there is a primary health care crisis in Nigeria. Infectious diseases, maternal mortality, infant mortality and malnutrition are the main public health challenges facing the country. It was reported that almost every year, approximately 58,000+ young mothers are dying because of inaccessible and poor maternal health care services in Nigeria. More than 35% of women received no pre-natal care, and more than half of new pregnant women received no skilled birth attendance. Almost 45% of recent births received no protection against neonatal tetanus. Only 23% of the children between the ages of 12-23 months received all vaccination as per the national program, this indicates that a number of children are still vulnerable to preventable life threatening diseases. With high maternal mortality of 814/100,000 live births and infant mortality rate of 70/1000 live births and other poor development indicators, lifelong risk remains high for young children, women and the general adult population in Nigeria. 

Our solution is an innovative public private partnership initiative where we partner with governments, donors and communities through our “Community Healthpreneurs” model to; gather data, establish, manage and operate primary health care facilities in their own communities. 

The primary health care facilities are built and equipped through community self-help initiatives with support from donors while the personnel, consumables and supplies for operation comes through a health/drug revolving scheme jointly operated by the 'community healthpreneurs', local government health department, the state ministry of health and the National Primary Health Care Development Agency. 

Our process begins with community mapping and PHC assessment using mapping technology and ODK open source software to identify rural communities without a PHC and those with PHC but lacks the basic infrastructures to meet the primary health care needs of the community. Using data from the mapping and assessment, we map out strategic actions to meet the identified and prioritized primary health care needs in the communities.

Women: Our solution facilitates access to maternal health services for women including basic pre ANC and post ANC services. It will also provide access to general primary health care services for women in rural Nigeria.

Children: Our solution provides access to routine immunization for children which will help prevent infant mortality due to avoidable childhood diseases. It will also provide access to general health care services for older children in rural communities in Nigeria.

 Youths: Our solution provides access to general primary health care services for youths including basic and essential adolescent reproductive health services for both girls and boys in rural Nigeria.

Men: Poor health seeking behavior is highly reported among men in rural Nigeria, this is partly attributed to poor availability of health care services. Our solution will definitely bring primary health care services closer to men and will positively impact on their health seeking behavior.

For 9 years, I and my team have worked with these target beneficiaries across different communities. We have lived and interacted with them at various levels while implementing various solutions to improve their wellbeing. From 2014 till now, we have consistently and progressively provided primary health care services for 8000 children, 3000 women and 1800 men in 8 communities in this terrain.

We work with the community leaders, groups and other stakeholders to identify and prioritize their needs and collectively, we mobilize resources towards meeting these needs.

We are seeking for new partnerships; new relationships that can provide us greater leverage to serve our target beneficiaries.

Partnership for change is at the Centre of the solution we provide as an organization. We have come thus far not so much of how much we have received in fund but because of the partnerships we have developed that have built and strengthened our organizational systems for efficiency and effectiveness. 

There are several innovative edges to our solution; 

Firstly, our solution comes with the power to centralize primary health care data and encourage collaboration among all primary health care sector stakeholders including service beneficiaries and local communities, this will further help in democratizing the delivery of primary health care services.

Secondly, unlike most NGOs that provides one off services for beneficiaries and communities, ELSOPHI’s community healthpreneur model builds ongoing relationships with community primary health care stakeholders that guarantees sustainability and quality service delivery in the primary health care sector. We combine public private partnership with a very strong community based approach while focusing on the needs of the communities, this way, we are also disrupting the 'heavily donor depended and donor driving' health care system in Nigeria.

Our community healthpreneur model is also an innovative health business model that enable communities to generate income for their own community while meeting their community primary health care needs; this way, the model is also disrupting rural poverty cycle ravaging Nigerian communities.

By empowering communities to take initiative and lead for their own primary health care needs, we are also disrupting the ‘politically motivated approach’ towards the allocation of primary health care resources in Nigeria; health is beyond ‘politics’ and should be seen to be so. Besides, when the people own it, they become more accountable in managing the processes and the primary health care outcomes is guaranteed to improve.

1. To strengthen and expand our institutional partnership base for health by 80% by 2027: To enable us accelerate access to primary health care services for our target communities and beneficiaries, we are driving strongly to strengthen, expand and diversify our partnership for health base. We will achieve this goal through increased advocacy and engagement with international, national and local health stakeholders in and outside Nigeria.

2. To facilitate the establishment/renovating/refurbishing of 7,500 primary health care facilities across rural communities in Nigeria by 2027: As our target contribution towards achieving universal health coverage in Nigeria, we are collaborating with communities through our 'community healthpreneur' model to build, equip and operate primary health care centers in rural communities in Nigeria. To achieve this, we are using the mapping technology to map out rural communities in Nigeria without primary health care facilities and consequently, mobilize resources through partnership with the government and other donors to provide the needed primary health care centers in the mapped communities.

3. To facilitate access to primary health care services for 45,000 women, children, youths and men in Nigeria by 2027: As part of our contribution to achieving universal health access, we are working to accelerate access to primary health care services for women, children, youths and men in rural Nigeria. We will achieve this goal through intensified community awareness, sensitization and referral for primary health care services. We will also conduct health facility mapping to enable us identify available primary health care facilities to facilitate linkage and referrals for our target beneficiaries.

1. Process Monitoring: We routinely capture program data including key service delivery statistics using mechanisms that measure critical indicators. Our staff and volunteers routinely capture data at service delivery points while the M&E officer collate the data on a monthly basis for storage, analysis and dissemination.

2. Individual-level Monitoring: monitoring is carried out for each beneficiary throughout and the results are used for targeted case management. Service delivery information are included in the individual tracking sheet, and used to simplify routine reporting, as well as analyze the relationship between the variety and intensity of services received and key outcomes. 

3. Strengthening Data Quality: To ensure that accurate data is generated and reported, we support capacity building of volunteers and M&E staff in data collection and management, conduct supportive supervision and provide regular technical assistance for staff and volunteers.

Measuring Indicators

Number of health advocacy conducted

Number of persons provided access to primary health care services disaggregated by gender, age and location.

Number of primary health centers built and equipped

Number of community health committee/improvement team established/strengthened.

We believe that you cannot improve what you cannot measure. By providing data for evidence based decision making for all health sector stakeholders and empowering communities to take the lead for their primary health care needs, we will improve access and coverage of primary health care services in rural communities in Nigeria.

Key Activities to be conducted includes;

1. Community and Primary Health Care mapping using mapping technology.

2. Primary Health Care assessment using Android ODK open source software.

3. Advocacy visit to government ministries, agencies and departments and other private sector donors to build strong partnership for improved PHC access and coverage.

Our solution uses mapping technology to map out rural communities without primary health care centers and communities with primary health care centers but lacks the basic and essential infrastructures to meet the needs of the people. 

We also utilize the open data kits (ODK) open source software to gather data in the field on primary health care service access, coverage and service uptake and create a central data base for the data. These data is also shared with relevant government ministries, agencies, donors and other relevant primary health care sector stakeholders for evidence based decision making on PHC service coverage and access in the rural communities in Nigeria.

ODK is an open-source software used globally by organizations in public health and global development to collect, analyze and store data. ODK has been proven to work anywhere, it is fit for use in rural areas because of its unique feature that allows both for offline and online data collection which can be later synched. It is also fit for mobile use.

Community health volunteers: These are community based volunteers who volunteers their services working with our organization to contribute in improving the wellbeing of our target beneficiaries. Their motivation is to contribute to achieving the goals and objectives of ELSOPHI while working to improve the wellbeing of the people in their own communities.

Community health committees: This is community based health committee established by the community gatekeepers and leaders to pursue the health interest of the community with focus on facilitating access to primary health care services for the community. Their motivation is to ensure PHC service access and continual improvement in their communities.

Community development associations: This is the decision making body in the communities that provide leadership for resource mobilization towards achieving primary health care goal of the community.

Community health extension workers: These are trained health worker who work in the various existing primary health care facilities in the communities we serve and intend to serve.

Gender equity and social inclusion is at the root of our work. Our organizational goal right from inception has been to foster social inclusion for the vulnerable and marginalized population especially; women, girls, children and youths.

This is evidenced in the composition of our board and the deliberate representation of women and girls in managerial position in the organization.

In staff recruitment, we are also very deliberate in giving fair and equal chances to women. We also have equity and inclusion provision in our organization policy documents regarding employment at all levels.

We operate as a not for profit social enterprise. Through participatory need assessment, we identify the need of our target beneficiaries and mobilize resources through grants and donations to meet those needs. Where we are unable to completely pay for the services with grants and donations, we subsidize the cost of services. We also leverage public private partnership as a strategy to provide access to essential services for our beneficiaries. We provide direct services to our beneficiaries working with trained community care workers who work with us a volunteers. Our beneficiaries want the services we provide because it meets their needs and offer them value that brings transformation and improvement in their wellbeing.

We are predominantly a grant and donation funded organization. We primarily source for grants through concept paper and proposal development. Our grant funding is complemented by income generating initiatives, through our income generating initiatives, we provide services for fees and sell products for revenue. We combine the integrated and external model for our income generating initiative. 

Thus far, we have received grant funding from the US Embassy in Nigeria, Catholic Relief Services and the Global funds awarded through competitive bidding processes that involved submission of concept paper and proposals. Through our income generating initiative, we have generated revenue while we have mobilized equity funding to run our business arms and to support our operations during periods when we don’t have grants funding running in the organization.