The Village Concept Health Initiative(VCHI)

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The Village Concept Health Initiative(VCHI)

Nigeria
Project Summary
Elevator Pitch

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The VCHI is primarily addressing the Primary Health Care (PHC) needs of the rural people in Zugurma/Mashegu LGA of Niger State, Nigeria. This is because primary health care accounts for up to 80% of the health care needs of the rural people. By focusing, on (PHC), this project is addressing the major Health Care priorities of the rural people. The VCHI recognizes that the cost of and burden of the emerging health challenges in a developing country like Nigeria have far outweighed the health budget of the primary duty bearers i.e. government. In the present circumstances, the group who are least protected and who suffer most are the poor who mostly reside in the rural areas. They lack access to affordable quality health care and at the same time, they face the unfavourable choices of unsanitary living conditions, poor nutrition, and lack of preventive health services. The projects primary beneficiaries are men, women, children and families in the remote rural villages of Zugurma/Mashegu LGA. The main services include: a) The Mobile Health Care/Clinic Services ? This is aimed at taking quality health care and clinical services directly to the doorsteps of rural people. In this way, the barrier of long distances and costs preventing the rural people from accessing health care services is eliminated. The mobile Health team visits the remote villages on rotational basis to deliver affordable quality Medicare to the rural people including medical consultations. The School Health Outreach/Services: This involves the visitation of primary schools in the various villages for Health education of school children and to Immunize them against the major killer diseases. . Most of the low-income and marginalized populations reside in the remote rural villages. By focusing solely on their health care priorities, this project is helping to improve health for all.

About You
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Your idea
Focus of activity

Healthcare Delivery

Start Year

2003/2004

Positioning in the mosaic of solutions
Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Design inclusive systems

Innovation
Description of health product/service offering:

The VCHI is primarily addressing the Primary Health Care (PHC) needs of the rural people in Zugurma/Mashegu LGA of Niger State, Nigeria. This is because primary health care accounts for up to 80% of the health care needs of the rural people. By focusing, on (PHC), this project is addressing the major Health Care priorities of the rural people. The VCHI recognizes that the cost of and burden of the emerging health challenges in a developing country like Nigeria have far outweighed the health budget of the primary duty bearers i.e. government. In the present circumstances, the group who are least protected and who suffer most are the poor who mostly reside in the rural areas. They lack access to affordable quality health care and at the same time, they face the unfavourable choices of unsanitary living conditions, poor nutrition, and lack of preventive health services. The projects primary beneficiaries are men, women, children and families in the remote rural villages of Zugurma/Mashegu LGA. The main services include: a) The Mobile Health Care/Clinic Services ? This is aimed at taking quality health care and clinical services directly to the doorsteps of rural people. In this way, the barrier of long distances and costs preventing the rural people from accessing health care services is eliminated. The mobile Health team visits the remote villages on rotational basis to deliver affordable quality Medicare to the rural people including medical consultations. The School Health Outreach/Services: This involves the visitation of primary schools in the various villages for Health education of school children and to Immunize them against the major killer diseases. . Most of the low-income and marginalized populations reside in the remote rural villages. By focusing solely on their health care priorities, this project is helping to improve health for all.

Description of innovation:

The VCHI is an integrated rural community based health intervention project aimed at making high quality health care delivery services available and accessible to the rural people at affordable costs. The project uniquely focuses on the pivotal role of grass-root community based health care delivery strategy in bringing affordable health care services nearer to the people. Our service delivery approach is an integrated model, which combines all aspects of primary health care including both curative and preventive aspects, which are administered as a combined package. We also have a simple team made up of only 3 persons ? The Primary Care Physician, a Community Health Extension Worker (CHEW) and a junior community Health Worker who serves as Nursing Aid. These three combinations have proved very effective and complementary in the field. The drugs and other pharmaceutical products dispensed to patients during consultation and outreaches are sourced from the government Drug Revolving Fund at subsidized rates and are given to patients with no profit margin, in this way the drugs are made affordable. The vaccines for mass immunization are sourced distributed free of charge from the Local Government cold chain/vaccine store. The Physician and the CHEW are not paid extra fees because they are already full time employees of the Local Government. The school health services are free. By visiting people in their remote villages, the project has succeeded in removing both the financial and non-financial barriers that hinder the rural people from accessing health care services. This initiative is unique because it is cheap and cost effective yet very effective and efficient.

Operational model:

The major activities of my organization is health promotion with a major focus on Primary Health Care and the realization of the ?right to health? of the rural people in Niger State, Nigeria. The VCHI is affiliated to the Department of Primary Health Care Zugurma LGA. This gives the project access to use all the primary health care facilities in the LGA in pursuit of our objectives. The project team and the organization are rural community based. Both members of the project team are residing within the project community. The project reaches out to the rural people through their various village mutual Health Associations. Bearing in mind that Africa lives within her villages and it is only at this level of cooperation that, sustainable solutions to Africa?s health care problem can be realized. This project recognizes that to be a meaningful collaborative force at the grass- root, we must be effective at the community level, understanding local perspectives regarding people?s health and well being, that is why we are engendering a dynamic community involvement and local action in all aspects of project planning through our various consultations with the various village/community stakeholders.

Human resources:

One of the unique features of this initiative is the simplicity of the project tam ? only 3 members make up the core team ? they are (1) The Primary Care Physician/Medical Officer who is the leader of the team, (2) The Community Health Extension Worker (CHEW) who assists the Physician and (3) A Nursing aid who is a junior community health worker. The Primary Care Physician is Dr. Chukwumuanya Igboekwu, Male, Nigerian, 27 years old. He obtained his Bachelor of Medicine and Bachelor of surgery degree from the University of Ibadan, Ibadan in September, 2001. He did his National Youth Service in 2003/2004 in Niger State. He is currently working as a primary Care physician/medical officer at rural hospital in niger state. He is currently an Action Partner of the Oxfam International Youth Parliament and has participated in several project management courses. Mr. Zakari Sahon-Rami is a Community Health Extension Worker (CHEW). He obtained his Community Health Certificate from the School of Health Technology Tunga- Magajia in Niger State. He is currently a staff of the department of Primary Health Care, Zugurma/Mashegu LGA in Niger State. Mr Baba is a junior community health work

Key operational partnerships:

The key partners of this initiative are: (1) The funding & and Technical Partners - The German Technical Cooperation Agency (GTZ) provided the major funding and technical support for the initial part of this project - They provided the clinical equipments, the initial drugs and provided funds for all the other logistics such as transportation of the mobile team and equipment to the different villages. (2) Government department of Primary Health Care Zugurma/Mashegu LGA ? They provide technical support and also gave the project access to all their Primary Health Care facilities in the different villages. They are providing the institutional base for the project. (3) The various villages/community mutual Health Associations ? They provided the key structures for the project team to reach out to the entire community. They were of strategic assistance especially during the planning stages of the project, and in mobilizing community members in support of the project.

Impact
Financial Sustainability:

<ul><li class="entry-label">Fees charged to clients?: <span class="entry-text">Yes</span></li><li class="entry-label">How do you assure affordability?: <span class="entry-text">Fees are only charged for drugs. All vaccine used for mass immunizations are sourced free of charge. The project adopted a drug revolving system so as to ensure a sustained supply and availability of drugs. Apart from drugs, all other services are free of charge. It must however be noted that the drugs are already being subsidized by the Zugurma/Local Government, taking into consideration the high level of poverty among the rural people.</span></li><li class="entry-label">Earned incomes as a percentage of operating costs: <span class="entry-text">10%</span></li><li class="entry-label">Other funding sources: <span class="entry-text">As it is now, the logistics aspect of the project is not financially self sustainable. Considering the fact that the ?right ?to-health? is a fundamental human right and that it is the duty of governments at all levels as the primary duty bearers to realize this right, the project is hoping to be integrated into the mainstream of the Primary Health Care Program of the LGA. In this way, sustainability is guaranteed. Also as a step towards self sustainability all the 3 members of the project team are already full time employees of the LGA.</span></li><li class="entry-label">Strategy for long-term sustainability: <span class="entry-text">As a long-term strategy, we are hoping that the new health care financing scheme i.e. the Rural Community Health Insurance Program, which we are currently running a pilot program in one community (Sahon-Rami) in the LGA in collaboration of the National Health Insurance Scheme (NHIS) and GTZ will succeed and put all community members into its safety net. Through this new financing mechanism, community members will make a financial contribution of N120.00 (&#8776; $0.80) monthly in return for access to Primary Health Care services. The contributions are pulled together into a common ?sickness fund? managed by the Community/Village Mutual Health Associations. In this way, financial sustainability is guaranteed.</span></li></ul>

Current and Future Impact:

<ul><li class="entry-label">Total number of clients: <span class="entry-text">4300</span></li><li class="entry-label">Clients in the past year: <span class="entry-text">1700</span></li><li class="entry-label">Percentage of low-income clients: <span class="entry-text">98%</span></li><li class="entry-label">Impact: <span class="entry-text">Although we recognize that the measure of success in health service delivery of this nature is often not easy to ascertain, especially in the short term, nevertheless, the implementation of this project has resulted in a tremendous reduction in the gap of unmet need for quality, affordable and accessible health care services for the rural people in Zugurma/Mashegu LGA, Niger State. The commencement of the project has also resulted in almost 300% increases in patients? attendance and utilization of health services and facilities in the various project locations. This can be attributed to changing community health seeking behaviour. Also a lot of women are embracing safe motherhood practices The LGA has now made Primary Health Care a top priority area on its program agenda. </span></li><li class="entry-label">Overall "market": <span class="entry-text">The VCHI has the potential to service the rural areas in all developing and poor resource communities, countries and regions of the world. This initiative (VCHI) has proven to be a successful prototype of what an integrated Primary Health Care service/program should be like, if we hope to geometrically accelerate the pace and scope of change in the rural health care development. It is a baby, which can be nurtured to full potential because it is cheap and cost effective. </span></li></ul>

Scaling up strategy:
Stage of the initiative:

<i>Scaling Up</i> stage.

Expansion plan:

Presently the project is being implemented in 4 villages/ communities in the LGA. It is our plan to expand our service delivery to more 12 communities in the next 3 years at the rate of 4 new communities per year. We also hope to acquire a fully equipped mobile clinic vehicle to make logistics easier. In the next 4 years, we envisioned that the project would reach all the 21 villages that make up the LGA with full-time project team personnel. We also expect the project the project to be fully integrated into the Primary Health Care program/Policies of the LGA.

Origin of the initiative:

This initiative started as part of the community development service Dr. Chukwumuanya Igboekwu during the period he was serving as Medical officer in a rural hospital in Niger State, under the compulsory National Youth Service Scheme in 2003. He holds a bachelor of Medicine and surgery degrees (MBBS) from University of Ibadan, Nigeria. The initiative was started to fill the unmet gap for quality health care services in the rural communities of Zugurma/Mashegu LGA in Niger State. Subsequently, he developed partnerships with GTZ and the department of primary Heath Care of Zugurma/Mashegu LGA for its implementation. He is a male, 27 years of age and an indigene of Enugu State, South Eastern part of Nigeria.

Sustainability
Policy change:

The Government, as the primary duty bearer to pursue a Health Sector Reform agenda based on a Right-based approach or model, which recognizes the ?right to health? as a fundamental human right as guaranteed by the various international frame works. This means the adoption of a National Health Strategy and program of action that will ensure universal access to Health Care for all citizens irrespective of their ability to pay. This entails the establishment of Health Care institutions or system and a new method of Health care financing that allows all Nigerians irrespective of their socio-economic status to obtain or access Health Care services. For this policy change to happen, governments at all levels must start seeing investment in Health care not as a secondary dimension of development but as central to the development process.