In Nigeria there are over 30, 000 Primary Health Centres (PHCs) with only about 20% working (Adewole, 2016) and in Akwa Ibom State, there are over 400 PHCs. Presently, most of the PHC facilities in Nigeria lack the capacity to provide essential health-care services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, lack of trust between the health service providers and community, poor condition of infrastructure, high fee for services and lack of essential drugs supply (Chinawa, 2015). The above has led to poor healthcare service delivery by the health workers in the PHCs and low service uptake by the communities thereby leaving most of the health facilities dysfunctional in the rural area. Primary Health Care (PHC) still remains the minimum package of healthcare that should be provided to every individual and community across Nigeria Health System. The aim is to improve relatively the health status of the nation ensuring provision of healthcare services to people in the rural area (Oluwasogo & Ibrahim, 2020). See more on Essien Udim.
Ukana West 2 Community Based Health Insurance (CBHI) Scheme was launched on the 21st August 2014 in the Primary Health Centre, Ikot Ideh, Essien Udim Local Government Area, Akwa Ibom State, Nigeria. CBHI is a not for profit organization and provides risk pooling (protection) to cover the cost of health care services. Not for profit health care financing mechanism which is based on solidarity (agreement, oneness) between members and democratically accountable to them. The program is managed by democratically elected members of the community who form the Board of Trustees with other stakeholders (Ministry of Health, National Health Insurance Scheme (NHIS),Hospital and the Local Government Council). The NHIS provides the technical support, supervision and pays a fee of $4.65 per head for every registered pregnant women and children under five years of age. The Ministry of Health supports the program with the deployment of health workers to the facility, supervision and provision of malaria drugs, HIV drugs and test kits. CBHI is actively involved in resource mobilization to ensure that the indigent are not left out of access to healthcare services and that financially able persons pay a fee of $12.90 per head to equally enjoy the program throughout the year. Ukana West 2 has a population of 19, 257, with about 8, 000 of that population is befitting from CBHI. Others who are not registered in the CBHI scheme make Out of Pocket Payment for healthcare services from within and outside the community.
FUNCTIONS OF CBHI IN HEALTH FACILITY
With community ownership and involvement in the governance and management of the CBHI Scheme and the facility, there is transparency in service delivery and accountability among the health workers. It also builds strong trust and relationship with the community health workers and encourages/mobilizes its family/people to access a 24 hours health services in the facility. Although most of the responsibilities shouldered by the Ukana West 2 CBHI are government’s responsibilities CBHI uses the fees paid to actively support the facility with the provision of deliverables (essential drugs, test kits, equipment, stationaries etc), provision of security personnel at the facility because of its 24 hours services, maintenance of the facility (minor repairs, sanitation and payment of utility bills), payment of its staff, capacity building for the health workers, and health sensitization programs in the communities. It also partners with NHIS/other relevant organizations to identify the indigent vulnerable groups and ensure that they have equitable access to healthcare services in the Primary Health Centre, Ikot Ideh throughout the year and secondary referral services (such as caesarean section, hernia, appendectomy, severe malaria, pregnancy scan and complicated labor) at Cottage Hospital, Ukana. Community Health Unit, University of Uyo Teaching Hospital routinely send in Medical Doctors for weekly consultations at the facility.
HOW EFFECTIVE IS THE COMMUNITY BASED HEALTH INITIATIVE (CBHI) INTERVENTION?
Before the inception of CBHI, the Primary Health Centre Ikot Ideh was dysfunctional with no drugs, high fees for services, lack of staff, poor service uptake and documentation of service uptake. Maternal mothers therefore resorted to quack medical practitioners and traditional birth attendance for health services. Since the inception of CBHI in 2014, there is a lot of improvement from the evidence below. It shows an increase in the service uptake in the health facility from qualified medical attendance by pregnant women and children under five years old.
Evidence of breakdown of service uptake by the indigent vulnerable groups in the Primary Health Centre, Ikot Ideh as a result of CBHI
|1||Total number of children immunized||473||1431||873||1106||1545||830|
|2||Total number of children under 5 years’ service utilization (0-5 years)||168||371||544||860||991||417|
|4||Total number of deliveries||29||29||43||67||47||52|
Source: Primary Health Centre, Ikot Ideh, 2020
In Essien Udim LGA, there are 18 PHCs, after the Primary HealthCare Base (headquarter) at Afaha Ikot Ebak. The most utilized PHC for healthcare services is the PHC in Ukana Ikot Ideh as a result of the CBHI. The reasons are obvious being that CBHI supports the centre with deliverables, are involved in the governance and management of both the facility, encourage its families/people to visit the health facility for healthcare services. If Nigeria intends to attain the 2030 UHC, one of the steps toward that is to strengthen its Primary Health Care system through the active involvement of community in healthcare service delivery via having CBHIs in all the political wards where there are PHCs. Keep tabs on them using Twitter
Adewole I. Thirty Six States and the FCT are to Share $1.5m FG Fund for Primary Health Care. (2016). Available from: https://www.informationng.com/2016/07/36-states-and-the-fct-to-share-1-5m-fg-fund-for-primary-healthcare.html
Chinawa JM. Factors militating against effective implementation of primary health care (PHC) system in Nigeria. Ann Trop Med Public Health (2015) 8:5–9.10.4103/1755-6783.156701 [CrossRef] [Google Scholar]
Oluwasogo A. Olalubi & and Ibrahim Sebutu Bello (2020). Journal of Primary Health Care and General Practice; Community-Based Strategies to Improve Primary Health Care (PHC), Open Access Journal, Volume 4 • Issue 1 • 030Review article, ISSN: 2637-7705.
- Lecturer/Researcher, Department of Agricultural Economic and Extension, Nnamdi Azikiwe University, Awka, Nigeria
- Project Consultant, Ukana West 2 Community Based Health Initiative (CBHI), Primary Health Centre, Ikot Ideh, Akwa Ibom State, Nigeria
- Member (Beyond-Aid) Track Changing Initiative Working Group of the Kampala Initiative (Medicusmundi International Network, health for all)
- Health Information for All (HIFA) Country Representative, Nigeria
- Member CODATA Data Science Journal Kampala INSPIRE Hackathon: an example of capacity development for agriculture
- Member Nigerian Universal Health Coverage Advocacy Network (NUHCAN) Partnership and Resource Mobilization Committee
- Member Civil Society Engagement Mechanism (CSEM)
- Founding Member Nigerian Universal Health Coverage Advocacy Network (NUHCAN)
- Akwa Ibom State Secretary, Nigerian Evaluators Association (NAE)
- Member Global Network for Disaster Reduction (GNDR)
- Member Nnamdi Azikiwe University Food Security Cluster research team