Equitable healthcare services to people with rare disease

The outbreak of human monkeypox was first confirmed in Nigeria by NDDC in 2017. In 2017, Nigeria had 146 cases from 22 States of the federation. The majority (62%) of the cases were in adults between 21 and 40 years and the majority of those infected were male. There is a recent outbreak again amidst the COVID-19 pandemic and to address these issues, CBHI a locally/nationally positioned Organization with huge resources of man and experience, with proven records in health care is better positioned than any other group to support delivery of Community health care interventions in Nigeria, sequel to Universal Health Coverage (UHC) focus on reaching every community with primary health care, we are applying for funds for the implementation of the ‘’improvement collaborative approach to a community-based rare disease prevention project’’. The project is aimed at contributing to the reduction of child and maternal mortality rates by improving behaviors related to health care sought by community members from professionals and building the capacity of the healthcare service delivery team in the facilities.

When you get sick in the rural area of Akwa Ibom State in Nigeria you have to pay for medical care. Typhoid fever, a bacterial infection that is endemic to the region, can cost up to a week's income to treat. Over 50% of people in the country live on less than $1.90 a day. A poor farmer in Akwa Ibom, typically growing cassava or palm oil to survive, makes hard choices when illness strikes. 

Ukana West 2 Community-based Health Initiative (CBHI), a non-profit organization, has worked directly with community members to develop a locally owned and democratically accountable health insurance system. Each person pays a community-set premium of $20 a year and gets free healthcare at the Primary Health Centre Ikot Ideh where the program is situated and secondary referral services at Cottage Hospital, Ikot Ideh. 

The initiative, which targets the most vulnerable people within the catchment area of 19, 257 with a population of 51, 779 has enrolled 5,400 people through payment of premium and its various fund raising activities. Since being set up, child immunizations for TB, polio and diphtheria have more than doubled amongst participants in the scheme. Four times as many adults now seek treatment at the facility.  Pregnant women and children under five years of age were not left out as they are the most vulnerable groups in the society.

The target population are the rural dwellers who are majorly peasant farmers living on less than $1.90 a day. A poor farmer in Akwa Ibom, typically growing cassava or palm oil to survive, makes hard choices when illness strikes. 

My solution will ensure that the identified persons have access to quality healthcare services at the Primary Health facility and referral services to a secondary health facility where necessary  

CBHI team is made of community members who form part of the Board of Trustees with a representative from the State Ministry of Health, Local government council and National Health Insurance scheme, medical professionals from the community health Department of the University of Uyo Teaching Hospital, Academia who is the Focal Person, Program Manager, Desk Officer, ICT Officer, Finance Officer who are all graduates, community volunteers, community health workers in the Primary Health Facilities.

There is a large inputs of the community in meetings and outreaches where the opinion of the people are considered and acted upon. During the mobile clinic and follow up services, medical issues are identified and taken care of by the CBHI team. The community involvement in the program ensures the sustainability and accountability process in the program

Equipment barrier, financial barrier, human capacity development barrier

Initially, the rural people were expected to visit the health facility for healthcare needs. CBHI innovative approach is to organize a mobile clinic where the underserved communities are reached and care is given. I expect this innovation to change the broader way of thinking or providing healthcare services to only the people that can access and afford it. Everyone life matters and we all need equal opportunity to services.

In the next five years, CBHI program and outreaches will reach out to the 31 LGAs in the State and healthcare services will be accessible and affordable to all. With the establishment of the State Health Insurance Agency which is only meant for the formal sector, CBHI will be expected to cover the bulk informal sector mostly the ones in the underserved communities.

The goals will be through rigorous resource mobilization, advocacies and engagement with stakeholders and sensitization programs in the communities.

The number of people that access healthcare services as a result of the CBHI program, the number of antenatal and post natal services, number children underfive immunized, number of community health outreaches, number of capacity building for the community health workers and percentage of community involvement in the healthcare service delivery

I expect my solution to reduce the mortality and morbidity rate in the community. My solution will also change the mindset of the communities on Primary Health Facilities and encourage active service uptake at the facilities. According to McKing et al (2021), in the rural communities because of the high burden of disease and dysfunctional health facilities, morbidity and mortality rate is high. in order to curb the increasing mortality rate, there is the need for a strengthen Primary Health facility and prioritizing the delivery of a basic minimum package of health of healthcare.

Having research and identified hindrances to accessing healthcare services mostly in the underserved communities, CBHI employed mobile clinic as a way of bridging the gap to access healthcare services and also employed mobile medical telecommunication for follow up services for people who can access good network

CBHI believe in inclusion where no one is left behind or out of the benefit. The CBHI team is made of both male and female. CBHI also provides an environment where people's views ideology, culture and religious are respected. Any medical history are kept in confident

One of the ways CBHI improves the wellbeing of the people it serves is through capacity building on income generating business which will also help the beneficiaries to continue uptaking medical services. CBHI collaborate with organizations on human empowerment to train the community people on trading of food stuff, hair dressing, barbing, tailoring, soap making etc

We sustain CBHI through resource mobilization, grants, premium payment and co-payment from clients.

CBHI have received funds from individual (USD7143.24) , World Bank Save One Million Lives (SOML) (USD, 10714.86) Association for Family Reproductive Health (AFRH) (USD2381.08), National Health Insurance Scheme (NHIS)(23810.79), Centre for Child Clinical Care (CCCC) (USD 3571.62), Premium (USD10238.64), Co-payment (2857.29)etc