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How to improve access to quality health services in Nigeria

By Chukwuma Muanya
04 November 2021   |   3:03 am
Worried about the poor health indices recorded by the country despite efforts by successive governments, the Environment for Health Development Initiative (E4HDI)

Worried about the poor health indices recorded by the country despite efforts by successive governments, the Environment for Health Development Initiative (E4HDI) has made recommendations on how to improve access to affordable and quality health services in Nigeria.


Chief Technical Advisor/Chief Executive Officer (CEO), Dr. Nnenna Ezeigwe, in an exclusive interview with The Guardian said one of the motivations for establishing E4HDI is the growing evidence that the health status and health outcomes of the population depend more on several factors than specific causative agents of disease.

Ezeigwe said these factors, collectively known as social determinants of health (SDOH) comprise conditions in which people are born, grow, live, work and age and include physical environmental conditions, socioeconomic status, education, place of residence (rural, urban, etc.), race or ethnicity, occupation, gender, religion, social network, violence, and individual lifestyles. “They are the root causes of most of the health issues we grapple with today as well as inequities in accessing health care and other social services. The brains behind E4HDI did a critical analysis and have concluded that universal health coverage (UHC) and other sustainable development goals (SDGs) would be a mirage without addressing the SDOH. Further they realised that few non-state actors are engaged in the area of SDOH and therefore committed to filling the gap through E4HDI,” she said.

On how to complement national efforts in protecting the environment and bridging health inequities towards the attainment of Universal Health Coverage and the SDGs, Ezeigwe said improving SDOH require interventions by several sectors of government. “Thankfully the Federal Government realised this and championed the development of National Multi-sectoral Action Plan (NMSAP) for non-communicable diseases (NCDs) in 2019. What is required is the diligent implementation of the plan, which, E4HDI would not only support but also engage other stakeholders, including relevant government agencies to drive and undertake other policy actions for a healthy environment, UHC and attainment of other SDGs,” she said.

The medical doctor said E4HDI is a start-up Non-Governmental Organisation (NGO) focused on promoting individual and public health by addressing environmental and other SDOH through partnership, advocacy, and community engagement.

Ezeigwe said the health of the population depends a lot on the environment and several social factors. The physician said, basically, E4HDI strategic plan stipulates deployment of partnership, advocacy and community engagement to promote Health in All Policy (HiAP) and improve public health. She said these strategic pillars are powerful in dealing with multifaceted issues like the SDOH where many players are required and one cap does not fit all. Similarly, Ezeigwe said whilst individuals stand to gain from measures targeting public health, E4HDI recognise the need to champion healthy lifestyles and other programmes for personal risk reduction especially for non-communicable diseases.

The physician said the organisation is borne out of concern for the double burden of communicable and non-communicable diseases plaguing the Nigerian society in a fragile health system, gross inequities, and evidence that the prevalent diseases are due mainly to environmental and social factors, and can be prevented or effectively managed by appropriate and timely interventions involving sectors other than health.

Ezeigwe said whilst Nigeria has made progress in controlling malaria, tuberculosis, Human Immuno-deficiency Virus (HIV) and other communicable diseases, the burden is still worrisome. She said, added to this now is the rising burden of NCDs, including cardiovascular diseases, cancers, diabetes, chronic respiratory diseases and mental health, amongst others, which collectively account for about 29 per cent of all deaths in Nigeria every year.

The physician, however, said the good news is that most of these chronic diseases are preventable. She said by addressing environmental and other SDOH the disease burden can be drastically reduced through time-tested strategies and this is where E4HDI is set to make a big difference. Ezeigwe said addressing the problem requires multi-sectoral action through HiAP; empowering the primary health facilities to undertake preventive interventions and manage uncomplicated non-communicable diseases; dismantling obstacles for citizens to obtain the health services they require when they need them and not go bankrupt because of that. She said E4HDI has the expertise and passion to work with the government and other stakeholders in these regards.

Ezeigwe said environmental and SDOH of health are critical to the attainment of UHC and SDGs, and this informed the programme focus of E4HDI. She said addressing SDOH and the attainment of the SDGs require stakeholders to work together, so E4HDI cannot achieve it alone, but they are motivated to play active roles by deploying their three-pronged strategy to raise awareness, conscientise the relevant gatekeepers and drive policy actions for reducing risk factors for NCDs; promote UHC; ameliorate the impact of climate change; as well as implement programmes that can engender positive lifestyle.

The physician said there are several factors that impact health outcomes in Nigeria at the moment, including environmental degradation, impacts of climate change, declining education, gender inequality, violence/insecurity and unhealthy lifestyles. Ezeigwe said it is worrisome that poverty is high in Nigeria where most health services are paid out of pocket by the majority of people. She said E4HDI is interested in improving access to health services and believe that empowering the Primary Health Care Centre (PHCs) to provide quality services to the people at that level of care is key to achieving this. “Environmental issues like air pollution and climate change are also areas where E4HDI would put in efforts,” she said.

On how to overcome or rather tackle the challenges of the COVID-19 pandemic and insecurity towards meeting the vision and mission of the organisation, Ezeigwe said the COVID-19 pandemic had a historic impact on E4HDI having delayed its programmatic take off in the first quarter of 2020. “The setback forced us to adopt innovative ways to move forward with our agenda. We embraced virtual engagements early with the help of Internet and limited physical interactions to the barest minimum with strict observation of COVID-19 protocol. Most of our activities including meetings, training and recruitments were conducted successfully through virtual platforms. Undoubtedly improvement in the security situation and abatement of COVID-19 pandemic would enable wider coverage of our services and programmes,” she said.

On how to promote public health in Nigeria and contribute to the attainment of Universal Health Coverage and Sustainable Development Goals, Ezeigwe said E4HDI is committed to advocacy and driving action for sound public health policies in relevant government sectors; promoting equitable access to quality healthcare especially at primary health care levels; implementing high impact programmes and projects targeting mental health and NCD risk factors in the areas of air pollution, use of tobacco and tobacco products, nutrition, alcohol and substance abuse as well as physical inactivity; and providing environmental and occupational health services to a wide variety of clients.

E4HDI came into being in 2018 as Incorporated Trustees of reputable and professional Nigerians of diverse fields of expertise to complement national efforts in protecting the environment and bridging health inequities towards the attainment of UHC and SDGs.

Members of Board of Trustees of E4HDI include: Prof. C.O. Onyebuchi Chukwu; Dr. Nnenna M. Ezeigwe; Muhammed Ibrahim Sani SAN; Ms. Chinyere Nzeduru; Dr. Victor C. Iwuagwu; and Barrister Obiageri E. Ariguzo.