Whose business is health?

The list of possible risks confronting pregnant women is long: bleeding, breach birth, prolonged labour, placenta retained longer than usual. “If you see any of these,” the song goes on in Igbo, “take her to a hospital so she doesn’t die.”In a drama presentation that comes later, it becomes clear-several inhibitions are stopping women-and other […]

The list of possible risks confronting pregnant women is long: bleeding, breach birth, prolonged labour, placenta retained longer than usual. “If you see any of these,” the song goes on in Igbo, “take her to a hospital so she doesn’t die.”
In a drama presentation that comes later, it becomes clear-several inhibitions are stopping women-and other residents of the university town of Nsukka with a population over 690,000 from accessing health services.
Enugu state has since adopted a district health system-in the same fashion as Jigawa-bringing all its health facilities into firmer control for oversight and spreading out to cover as much grassroots as possible. In 2008, it started free maternal and child services statewide.
Nsukka alone has 41 primary health facilities and 46 private hospitals, but new government requirement mandating women to show their husband’s tax clearance certificate-or a tax exemption certificate-has cut down the number of people showing up to use them.
In other hospitals, women are turned away by demand of registration fee ranging between N100 and N500.
“In some places, people do not even access the facilities,” says Crownwell Chibuzor of Youth Education on Human Rights and Civic Responsibility.
“In other places, they access services on payment of N100, and the issue of 100 naira represents intermediary interests, because that is not paid into government coffers. You are now paying to somebody who receives salary from govt and at the same time collects N100 as an alternative to tax, which enters his or her pocket, and government is on the other hand losing.”
But it is the country at large that loses more. Nigeria still lags behind on its health indices, says Mike Egboh, national programme manager for Partnership for Transforming Health II (PATHS2), a UK-funded project to boost health delivery in selected states including Enugu.
“We are just 2% of global population, but we contribute 10% of maternal mortality,” Egboh told a packed crowd of some 3000 residents gathered to access free health services at Nsukka’s Government Field early August.
“The long queues here show people are not going to health centres,” he added.
The disenchantment came from people who went to hospital and didn’t see doctors, drugs or nurses and are “afraid of going back,” said Egboh. “We have to let them know things have changed.”
What changed is PATHS2’s providing drugs to 373 health facilities in the state through a drug revolving fund. Seventeen health centres were renovated and supplied with medical equipment, along with inverters and generators for independent power supply running into billions of naira.
In Nsukka, it paved way to make the local government area a model for how to improve health services.
In apparent cooperation, the council government has distributed drugs estimated at N5 million since last year in two batches, with a third slated for later this year.
Where staff was in short supply, PATHS2  provided volunteer doctors to man hospitals. Fifteen such volunteers attended to men, women and children who showed up for free health services at a town hall meeting, using up nearly N400,000 worth of drugs PATHS2 sourced from pharmaceutical companies.
PATHS2’s mobilisation of Nsukka is to get people to seek health services in dozens of renovated and newly equipped hospitals, stocked with drugs.
Civil society groups want Enugu government to drop tax clearance as a requirement, which has stopped people visiting hospitals, according to Chibuzor.
“The moment government tells them the issue of tax is now removed, they are going to embrace the facilities with speed. Why did they come after all, they came because they know they are going to access services free here. If they now understand they can access services free at the facilities, they will all be there,” he said.
“There are people who don’t even know the drugs are free, but we have mobilised them,” said Enugu health commissioner Dr George Eze.
In moves toward toeing the line, he called illegal charges an “extortion and sabotage”, insisting resident women and children “who are not supposed to pay are not to pay” and declared the health ministry would open a hotline where residents can report healthworkers demanding payment.
But a certificate showing tax clearance-or exemption from tax-remains a requirement, though doctors are expected to waive it in emergencies. So too other concerns among residents of Nsukka-ranging from diagnostic centres and hospital security to on-site accommodation to keep healthworkers and emergency transport service for pregnant women in places where terrain poses grave challenge.
They are all serious setbacks that threaten health for Nsukka. Their effects are not seen in the statistics of maternal deaths, but in an individual life cut short. There might still be hope, as antenatal clinic attendance at Nsukka district hospital-renovated and equipped by PATHS2-climbed from 455 in 2011 before the interventions began to 1034 this June.
“We will only know when it affects us,” says Egboh. And getting Nsukka residents and authorities to embrace their clinics and make their health a priority is a first step. “The purpose is to make health everybody’s business,” he added.