Ringim: ’Making health everybody’s business’

Last week   town criers were busy in Ringim, Jigawa state, inviting the townspeople to the Durbar Ground at the Emir’s palace, where a lively health fair as well as a community mobilization event held on Saturday. Hajiya Hafsatu Abdullahi is one of the many women who heard the call of the town crier in Ringim. […]

Last week   town criers were busy in Ringim, Jigawa state, inviting the townspeople to the Durbar Ground at the Emir’s palace, where a lively health fair as well as a community mobilization event held on Saturday. Hajiya Hafsatu Abdullahi is one of the many women who heard the call of the town crier in Ringim. One of her   grand children fidgets against her right shoulder when Weekly Trust comes across her at the sunny Durbar Ground which is ringed with canopies for the event. She is 44, has eleven children, and is treating an Ulcer, which has caused her not a little discomfort, she says, while gently rebuking the child .She is hopeful that the Doctors will take a second look at her condition, and adds that the town crier had mentioned a free diagnosis and treatment for the people at the event .According to her many locals in the villages are very poor and do not have money to feed, not to speak of buying drugs or making short trips. In her opinion this community mobilization effort is well worth it. But she is happy to have come down from Auramo,her community,and  says that  after seeing the Doctor, she will go back and make better use of the health facility near her house,and hints that she will  spread the news when she gets home.She  adds  that she has picked up some new health tips already just by listening patiently  to the medical team while on the line.Here  is a sharp country woman. To her right the Health Fair is in progress. Men and women from communities in   Ringim local government area have formed fairly long and orderly lines. At the head of the line is a medical team which listens to each patient and prescribes the necessary medication, or gives a referral. There is a lot of energy radiating from the men and women on the lines. The aim of this Fair is to show the  ordinary folk that similar  functioning health opportunities can be found at  any of the communities in Jigawa state,and is an encouragement to the people to  go back and make use of such .It focuses on the health challenges faced by pregnant women and   under 5 children. Traditional and religious leaders, Community Based Organisations, Women groups, Youth groups and many Development partners were present at the event. The Fair or awareness raising event is organised by PATHS2, a 6 year DFID funded project which seeks to raise health service delivery in five states in Nigeria. Ringim local government is a model local government under the PATHS 2 initiative.According to the website of PATHS2, in Jigawa state Maternal Mortality Rate (MMR) is estimated at 2,000 deaths per 100,000 live births. There is also the problem of low Ante Natal Care coverage. For every thousand children born, 98 will die by the age of 5.The state also suffers from an acute shortage of health manpower, the website adds. Jigawa state is the only state in the Federation which disburses 15 % of its resources for health, and this is in keeping with the WHO requirement. This means that with a little more effort the state could do very well in terms of health service delivery, because the political will to support this noble ambition is there.
Next on the line is Hafsatu Garba, 57. She too heard of the mobilization effort. She is childless,and says that she has been sick and was admitted thrice at the  health facility located in her community.She  adds that she will go back and make better use of the facility  she has been visiting. Mohammed Garba is a Teacher, and a resident of Ringim. His words ‘We were invited by the Ringim Emirate Council to witness the occasion. We are all very happy about this event. There are many of us gathered here and some have already been attended to by the medical team.’He adds that this will encourage people to make use of the hospitals and clinics in their communities. He is 40 years old, has 8 children, and went along to the event with his wife, who was also queuing to meet the Doctor on the other long line already forming for women. Audu Abubakar, one of the many Mai Ungwar in the Emirate, is present too. His words ‘I am very happy and excited to be here .This event will help the people who are not well,and we will go home to remind the people to make use of the facilities in the community. ‘Thus, a Teacher, a Ward Head, and a grandmother, in this instance, have become useful vehicles in mobilizing communities to access health facilities near them .During the event there was a performance which outlined challenges a woman faces while pregnant and what her spouse should do to assist her.The unacceptable attitude of some health workers at health facilities, which sometimes scares away patients, was also highlighted. The performance was well received by the audience.
Then there are the Chairmen of the facility health committees present. Umar Faruk Haruna  is one of them and belongs to the Ringim Committee of Friends,a group which works with PATHS2 in building the capacity of local facility health committees who work at the grassroots  level for the improvement of the facility.He  describes the situation in Sankara ‘For instance in Sankara where we started, the facility had very low attendance.Sometimes,if a client went to access the community ,he will be unable to access it ,or  there is a misunderstanding between the facility staff and the client. Thus the facility health committee will involve the community in taking decisions, including the facility staff.’He also speaks of another community where the women refused to make use of the health facility.His words ‘The women do not patronize the facility,instead they go to some nearby facilities. This is simply because of the poor attitude of the person in charge .The women refuse to use the maternity service, for the simple reason that some of them prefer to squat and deliver, instead of lying on the bed, and the committees have to try to work on these issues’.The women also refused to patronize another facility where there was no toilet.The women only started going there when a toilet was provided. Waiting nearby is Mukhtar Abdullahi Sankara who is Chairman of the facility health committee, Sankara health care centre.He says that the poor attitude of staff at the Sankara facility affects patronage by members of the community. He adds that in addition to this, many of the facility staff resides in Ringim which is some distance away, and that there is no maternity service at the facility.
All this information leads us to Dr Amina Aminu Dorayi, the Director of Service Delivery at the DFID funded Partnership for Transforming Health Systems in Nigeria (PATHS2). She comments on the significance of the occasion ‘This event is a community mobilization event.The aim is for the community to know that these services exist, because in some areas the people do not know that there  is something available for them,like a primary health care facility.What we want is a better relationship between the community members and the facility.We also want health to be everybody’s business. What this means is that if the community owns health care, then the health care will be theirs.They will know what their rights are, and they will go to the health care system, and fight for it. Ringim too is a model local government. Not only people in Jigawa state, but even people from other states of Nigeria will like to see what is happening in this state.’ She adds ‘We are trying to make Ringim a model for the delivery of health services for Nigeria as a whole’.
Kabiru Mohammed Dabi, Chairman local health committee, Dabi primary health care clinic also applauds the day’s event, as Dr Aminu just did. His words  ‘it shows the world and PATHS2 that the health committee members  have learnt a lot,  and that the training they recently received has made a tremendous change in their lives’.He adds  ‘previously people saw the  health facilities as government property,and so they did not use the facility .But now because of the training they have received people have started to embrace the facility.’He also  speaks on the significance of the  event.His words ‘The importance of the event lies in the fact that the people now have ownership of the facility,and  it would  help them to show that things are no longer as  they were  in the past.
 Hudu Tanimu, the Beguwa facility Chairman speaks in a similar vein. He also explains some of the challenges which dogged the Beguwa facility. His words ‘The lack of midwives, absence of laboratory technicians, and non availability of ante natal services, were some of the major problems at the facility. Due to the absence of ANC services, most women wouldn’t go to the facility, and many would lose their lives in consequence of this.’ The outcome was a steady migration of the people to other neighbouring facilities where these services were available.
Dr Mike Egboh, National Programme Manager, PATHS2 in his speech at the event described the occasion as ‘an interaction between the community and the government.’ He added that the event was brought to Ringim because of the support which the Emir of Ringim, Alhaji Sayyadi Mahmud, has always given similar events. He lauded the enthusiasm shown by the Jigawa state government as well as the Ringim local governments support for the day’s event. In a paper presented earlier  in the year, he states ‘In a poor, subsistence economy such as Jigawa’s, a mother or father falling ill or dying because of a lack of access to basic health care or drugs can have a momentous impact on the lives of surviving members of the family, and perpetuate the cycle of poverty and deprivation.’
The Jigawa state government ,as a reaction to the  poor health indices, set up the Gunduma Health System(GHS) which is designed to  address challenges in the health sector in Jigawa state,and is the Jigawa version of the WHO  recommended ‘District Health System’.It is the system used by many developing countries to provide quality health services to communities as an integrated health system that brings both primary and secondary care services under one management structure and accountability’.(PATHS2.ORG). Dr Hamza Abubakar  ,an official of PATHS2 tells Weekly Trust ‘What is happening here today  is very significant, for whatever you do to develop a health system, if the people do not access the service, then it is almost like a waste. Thus with the support of the Jigawa state government, as well as the help of Gunduma, more people are becoming aware of the benefits they derive by accessing various health care programmes.’ He adds that PATHS2 has turned around the health facilities in the state. Most of them are clean, backed up with drugs and a well motivated staff. It is just left for the communities to make good use of these facilities, he says.
Five years down the line, what developments would have happened in the state given the present momentum   initiated by PATHS 2? Dr Amina Dorayi says ‘This is just the beginning. If more community members are involved in health care, the local government chairmen, the traditional rulers, religious rulers, if we are all involved in health care, then Ringim will become a model local government. Even as the event  drew to a close  there were still lines of happy  locals  waiting to be examined by the medical  team , indicative of a new interest  in health facilities which have been refurbished ,and   fully stocked  with drugs. Already there are signs that the turnout at many of the facilities has increased. As one respondent from a distant community put it’. The poor attitude of the staff is still there, but its not like before. Things are looking good at the facilities .At one  of such  the ordinary people contributed over 3 million Naira in repairing and providing equipment for the clinic. Another facility initially had four staff, but pressure from the facility committee made an additional 3 to be added to this number’.
A  quiet but radical  change is taking place in Jigawa state.It involves everyone for it is also a community event – Imams, Teachers, grandmothers, grandfathers, politicians, traders, towncriers, labourers are all part of the great effort.
The trip to Ringim was sponsored by PATHS2.