Mike Egboh is national programme manager of the Partnership for Transforming Health Systems, Phase 2 (PATHS2). The opinions expressed are his own.
One of the key debates around issues of social justice to emerge in recent decades has been in the arena of bioethics. This debate centres on the principle that social injustice occurs when there is an avoidable difference in the health outcomes among a population of people, and a failure by the state to introduce measures which ensure that members of the general population have equal access to basic health-care services irrespective of their standing, income or ability to pay.
Nowhere is this principle more clearly illustrated than in Nigeria, Africa’s most populous state. The statistics speak for themselves. The 2010 Human Development Report ranked Nigeria 142 among 169 countries on the Human Development Index.
Life expectancy at birth is low, at 47 for males and 52 for females, and the probability of under-5s’ mortality is 157 per 1,000 live births. Maternal mortality is among the highest in the world at 545 per 100,000. In some states it’s as high as 1,500 per 100,000 live births (Nigeria Demographic Health Survey 2008).
Apart from a lack of financial resources and structured health systems, the medical "brain drain" - which sees many of the country’s top doctors and nurses emigrate in search of higher income and better lives for themselves and their families - has contributed to a dearth of trained human resources.
Inevitably, it is the poor and socially disadvantaged who bear the brunt of Nigeria’s iniquitous health system. At least 70 to 75 percent of health expenditure comes from out of pocket expenses. The wealthy and middle classes either have access to private or insurance based health care, or will travel overseas to access it.
For the past 10 years, Partnership for Transforming Health Systems (PATHS2), now in its second phase of operation, has been working to address the inequities in Nigeria’s fragile health infrastructure.
PATHS2 is funded by UKaid from the Department for International Development (DFID). It seeks to lift Nigeria’s citizens out of poverty through fundamentally improving their health outcomes, working both with national and state level governments to influence systems and policies, and also at grassroots level in five focal states of Enugu, Jigawa, Kaduna, Kano and Lagos, where many of its interventions are having a positive impact on the lives and well-being of the poorest, particularly expectant mothers and children.
Aside from high level interventions aimed at improving the overall functionality and accountability of Nigeria’s health system and increasing connectivity between federal, state and local health authorities, PATHS2 is focusing efforts on the ground with a series of interventions which are having a transformative effect on the lives and health outcomes of Nigeria’s poor.
In its focal states, PATHS2 is facilitating much needed refurbishment of previously dilapidated health facilities, and improving staffing so that local residents who were previously reluctant to attend are now flooding back to access services.
One centre in Jigawa formally seeing just 80 clients a month now regularly deals with more than 400 people monthly. Another health centre in Kano whose patronage was low, averaging 200-300 patients per month now records 2,000 patients attending per month.
Through the establishment of Facility Health Committees drawn from local citizenry, these health centres have become more accountable to the communities they serve.
PATHS2 is also playing a key role in recruiting, training and deploying medical staff, particularly midwives and community health extension workers.
For instance, as of December 2009, there were only 29 midwives in Jigawa serving a population of nearly five million. With support from PATHS2, the state government began an emergency recruitment drive to employ health workers to serve in remote, rural health centres.
In the past three years as a result of PATHS2 support, the number of midwives in Jigawa has increased from 29 to 268.
PATHS2’s innovative Drug Revolving Fund means that essential drugs and equipment are always to hand, where once stock outs of even basic supplies were commonplace.
The Emergency Transport Scheme, which works with taxi drivers’ unions to establish free transportation of pregnant women in distress to emergency health facilities in rural communities, is saving hundreds of women and new born children’s lives every month.
Over 2,027 pregnant women’s lives have been saved as a result of the scheme, which started in April 2012. The programme is also piloting a health insurance scheme which is affordable to poorer people.
While the work in the five focal states is having a profound impact locally, PATHS2 is indirectly achieving impact nationwide, as more and more of Nigeria’s 31 other states are being influenced and look to replicate the innovative "concentric service delivery model"; a replicable model to deliver quality maternal and child health services and other initiatives.
The aim is that PATHS2 will have a catalytic effect in Nigeria, and will help to realise the ambition of bringing social justice in healthcare to all of its 167 million people.