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TStv Africa

I was pleasantly surprised when on 18th of April 2019 I received an email from the Imo State Technical transition Committee acknowledging receipt of my memorandum and informing me it has been forwarded to the appropriate committee. Surprised because these call for proposals usually don’t amount to much and seem to be just a public relations exercise by most incoming governments. I’ve sent in these proposals before with previous administrations, but this is the first time I have got any response back. At least it suggests that the incoming government be proactive sincere with this. Fingers crossed time will tell.
Another positive is the effort to engage on social media by requesting comments and suggestions for development in Imo State. I’ve engaged with some of the discussions and find some of the suggestions are realistic and useful advice to the incoming administration. We are certainly overdue for a more robust infrastructure development in Imo State beyond cosmetic and facile efforts by previous administrations. We certainly need a robust road network in Imo state if commerce is to thrive. I would go so far as to even suggest that electricity generation and distribution should be a priority of Imo State government if we have any hope of sustained development.

However, in all these discussions and commentary there has been very limited discussion of health. Sadly, this is not just a reflection of the leadership but also the society at large. We take health for granted until something goes wrong then we look for whom to blame. In Nigeria now if you have a road traffic accident with major injuries that’s just a death sentence because we have virtually no emergency services. People are so misinformed about their health that even when the appropriate services are available they don’t even know about them. I bet you that if anyone with some financial resources in Owerri, had a stroke they will be looking for urgent flight to India or South Africa, even though one of the few stroke care facilities in Nigeria is in Owerri. Yes, you read that right, one of only 2 privately own dedicated stroke care facilities in Nigeria, with full compliments of professionals is here in Owerri Imo State (regions Stroke and Neuroscience Hospital). Yet very few people really know about it. So, think about this, for any intervention on a stroke patient to be effective treatment has to be started within 4.5hrs of the stroke. Someone has stroke in Owerri, what do you think will happen to him? First of all, they will call his son/daughter in Germany or USA for help. They’ll suggest you make quick arrangements to go to South Africa or India. By the time they are ready to do anything it’s probably days in a local private hospital where they will be advised to pray for him. Even those that know about the stroke centre Owerri will have their own challenges getting there. We have no emergency services to speak of, so you just have to take him in your private car through traffic to get there. Remember when we had Ebola in Nigeria. There was no public notification system at all so people either heard it from friends or on the radio. Many Nigerians thought you could cure it with salt water. Many even thought that spiritual or traditional healers can cure it. They even thought you can get it through the air you breath or by mosquito bite. There is no clear way to inform the people about it adequately.
Athough there are many areas that need urgent attention I think health should be prioritised. And there are many effective solutions that can be put in place within 6-12 months that may be effective and cost only around the price of building a 40km road. Below are some of my suggestions:
Health Insurance and Primary health services:
First and foremost, it is essential that the Imo State health insurance scheme that is being set up continue till full realization. This will greatly extend health care access to a significant proportion of Imo state indigenes where out-of-pocket healthcare expenditure is in excess of 92%. According to WHO 60% of Imo citizens live in abject poverty which means that a total of approximately 3 million Imo citizens would face catastrophic challenges if they get any serious health care problem. It is imperative that this work continue to fruition. Concurrent with this is the reactivation of the primary health care centres (PHCs). Most of the over 300 PHCs in Imo State are derelict. The PHCs are designed to be an integral part of any viable health system. It’s really disappointing that they’ve been so neglected. Their main functions include health education, disease prevention and control of locally endemic and epidemic diseases. Promotion good nutrition; safe water and basic sanitation. maternal and child health care, including family planning; immunization against the major infectious disease. Finally their function include treatment of common diseases and injuries; and provision of essential drugs. They are the frontline of our healthcare and should be the first port of call for most Imo citizens. Unfortunately current status of primary care in Imo state is dismal. My suggestion is that we engage private stakeholders in a public private partnership or even outright lease of these facilities to private healthcare practitioners with the government playing supervisory role. Whatever approach we decide on I suggest a proper pilot study of perhaps 10 PHCs before full role out.

Outbreak notification and Public awareness:
It is really disappointing that we do not have adequate means of notifying Imo citizens of disease outbreaks or creating awareness of common diseases. Radio and television announcements play a key role in this but require that people turn on and listen.

PHCs would be an excellent resource especially for endemic disease.
My suggestion will be that we use a notification system that is directly and immediately accessible to Imo citizens. A system that uses the phone networks has the capacity to instantly reach citizens within minutes of activation and should be explored.
I have thought about this challenge for the last few years and developed the Hudibia app specifically to tackle this. It has an instant notification system for outbreak and also allows users to report outbreaks. It also serves to create a health education component that is directly translated into the three major Nigerian languages for those unable to read English. This extends the reach of the notification.
Medical hotline:
There are so many misconceptions and lack of knowledge of even the available health care services in Imo State. This is why it is important that there is a hotline that is accessible to all Imo citizens. This should be accompanied by a knowledgeable staff with in depth knowledge of our healthcare system and an adequate database of health services.
Create Database of all medical facilities and personnel:
In line with a hotline it is important that all registered medical facilities
and health care personnel be added to a database that is easily accessible to the citizenry.
This should include their specialities and available services. This will make it easy to access these services and help prevent quack practice.Using smartphone technology, we have developed a feature that will locate a hospital or doctor by specialization and pinpoint the location by GPS
Integrate diaspora healthcare professionals into Imo health system:
One of our key resources in Nigeria are the diaspora health care professionals. A significant proportion of our homegrown healthcare professionals have migrated to other countries where they have acquired new skills and can contribute locally to our health system. Many come home regularly for medical missions. Given the foregoing it is imperative that we optimise their valuable contribution. We need to develop a database of diaspora professionals of Imo descent who will be interested in engaging to improve our health system. There should be an online logistics system that can be used to catalogue availability and specialty. It is important that diaspora involved in medical mission also commit to training local staff. Dedicated specialist teams should be created to cater to areas of need to support both training and clinical services. Tighter integration can be developed using telemedicine for remote consulting and monitoring of patients in Imo state.
I believe that most of what I have outlined above can be achieved in 6 to 12 months. When fully implemented it has the capacity to Imo State at the vanguard of public health systems in Nigeria and at a comparatively little cost compared other major infrastructural projects

Ahjoku Amadi-Obi is the founder of Hudibia a digital health platform focused on low resource environments

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