To ensure access to affordable healthcare services for all

Malaria, HIV and TB are major public health problems in Nigeria. They are major causes of poverty and low productivity in the country. Malaria, HIV and TB are major public health problems in Nigeria, and account for more cases and deaths in the country than any other country in the world. Malaria is a risk for 97% of Nigeria’s population and the remaining 3% of the population live in the malaria free highlands. There are an estimated 100 million malaria cases with over 300,000 deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from HIV/AIDS. Malaria accounts for an estimated 11% of maternal mortality. Malaria causes anemia which may require blood transfusions, a procedure that increases the risk for HIV infection where universal blood screening is yet to be achieved. People living with HIV/AIDS (PLWHA) are at an increased risk of clinical malaria, severe illness, hospitalization, and death. Malaria contributes to a temporary increase in viral load among HIV-infected people which may worsen the clinical disease, increase mother-to child transmission, and augment transmission in adults. Malaria accounts for 60% of outpatient visits and 30% of hospitalizations among children under five years of age in Nigeria. Research shows that the South-South zone of the country has the highest HIV prevalence, at 3.1% among adults aged 15–49 years. HIV prevalence is also high in the North Central zone (2.0%) and in the South East zone (1.9%). HIV prevalence is lower in the South West zone (1.1%), the North East zone (1.1%) and the North West zone (0.6%).

Akwa Ibom state according to HIV/AIDs indicator and impact survey (NAIS) has the highest rate of HIV in the country. The result indicates that about 5.5 percent of the people living with HIV in Nigeria are in Akwa Ibom State. The percentage of People Living with HIV (PLHIV) in Nigeria, among the age group of 15-49 years is 1.4 percent (1.9 percent among females and 0.9 percent among males).

Malaria has the greatest prevalence, close to 50%, in children age 6-59 months in the South West, North Central, and North West regions. Malaria has the least prevalence, 27.6 percent, in children age 6 to 59 months in the South East region. Although malaria is largely preventable through, among other methods, the regular use of insecticide-treated bed nets, the availability and use of long-lasting insecticidal nets (LLIN) in the rural communities of Nigeria is very low. Furthermore, though malaria can be severe, early and appropriate treatment is very effective. However, in the rural areas of Nigeria, care-seeking outside of the home is very limited; in the rural areas, a large number of mothers first sought home-based care before seeking outside care for counseling and treatment. Though home-based care can be effective, it is essential that caregivers are knowledgeable about proper home treatment, as well as dangers signs requiring medical attention. A failure to recognize danger signs and a delay in treatment often has serious consequences, including death, especially for children.

A comparison of the Global TB reports for 2018 and 2019 showed the disease burden is increasing in Nigeria in sharp contrast with the improving global outlook. Tuberculosis incidence rose in Nigeria from 418 000 cases in 2017 to 429 000 cases in 2018, and deaths also rose from 155 000 to 157 000 within the same period, with tuberculosis treatment coverage stagnant at 24%.

To address these issues, CBHI a locally/nationally positioned Organization with huge resources of man and experience, with proven records in health care is better positioned than any other group to support delivery of Community health care interventions in Nigeria, sequel to Universal Health Coverage (UHC) focus on reaching every community with primary health care, we are applying for funds for the implementation of the ‘’improvement collaborative approach to a community-based malaria, HIV and TB prevention project’’. The project is aimed at contributing to the reduction of child and maternal mortality rates by improving behaviors related to health care sought by community members from professionals and building the capacity of the healthcare service delivery team in the facilities.

CBHI aims to improve the access to basic curative and preventive health care services for vulnerable groups (Elderly, Children under five years old, pregnant women, widows, orphan 0-18 years, physically challenged and PLHIV) in the11 wards of Essien Udim Local Government Area, Akwa Ibom State. Proposed activities will focus on meeting the health cluster’s strategic plan and response objectives through the provision of primary and secondary emergency and reproductive healthcare and focused gender-based violence prevention and response services.

Through the proposed activities, CBHI intends to increase access to and utilization of quality primary and secondary health care and integrated HIV/AID services and improve access to quality maternal, sexual and reproductive health care.

The project will address the specific needs and concerns of different gender and age groups through age, gender and diversity mainstreaming. The project will ensure intervention address specific needs of vulnerable groups, males and females and build local capacity of project beneficiaries by designing gender sensitive health interventions.

To address the health needs of vulnerable groups (Elderly, Children under five years old, pregnant women, widows, orphan 0-18 years, physically challenged and PLHIV), identified in the needs assessment as having difficulty accessing health services, CBHI medical team will provide outreach primary health care through mobile medical clinics.

CBHI will contribute to the health cluster’s profile through:

• Maintaining emergency primary and secondary health care services through provision of basic equipment, medical supplies, basic lab equipment and supplies including those to maintain VCT and PMTCT.
• Supporting functioning health facilities in rural locations, and increasing provision of care via mobile medical units in remote or underserved pockets of the LGA.
• Supporting immunization via fixed and mobile health clinics targeting vulnerable groups including emergency mass vaccination campaigns
• Re-strengthening medical education and awareness raising messages through outreach community mobilization efforts with the deployment of community volunteers.
• Provision of essential package of reproductive health services in affected communities (safe deliveries, acute newborn care, care for victims of SGBV, and mitigating HIV in emergencies) which will include training a cadre of health workers on PMTCT.

CBHI was born out of concern for the increasing generally poor and inequitable access to quality and affordable healthcare services in Nigeria, this has made life very miserable for the citizens, and leads to short life expectancy, high morbidity and mortality of Nigerians. On August, 2014, Ukana West 2 Community Base Health Initiative (CBHI), a non for profit community based organization was established by Management Science for Health (MSH) sponsored by USAID to address the issue of ailing health facilities, poor service delivery and uptake and, inequitable access to quality healthcare services so that Akwa Ibom State can attain the UHC 2030. In order to ensure that registered members enjoyed quality healthcare services, CBHI partners with Community Health Department of the University of Uyo Teaching Hospital (UUTH) for weekly Doctor Consultation services at the facility. CBHI also have Medical Doctors, Pharmacist and Laboratory Scientist posted to the facility. Financial members of the community/state pay a premium of N10, 000 to benefit from CBHI services for a year at the health facility, Ikot Ideh. For no one not to be left behind, CBHI identify the indigent in the communities and solicit for funds to ensure this group also benefit.  

Equipment barrier, financial barrier, human capacity development barrier

What makes my solution innovative is the mobile clinic that CBHI operate in the rural communities where there are no road network and health facilities. CBHI runs a quarterly mobile clinic and a follow up on patients which makes it acceptable and affordable for the people

In the next five years, CBHI intends to cover the entire 32 local government area in Akwa Ibom State and reach out to a larger population of the people living in the rural community. Currently, we are attending to 12, 000 patients and in five years times, we are targeting 500, 000 people in the State to have access to affordable healthcare services via CBHI program.

The mortality and morbidity rate in the State should reduce by 45% in five years time through rigorous health sensitization program and strengthening the Primary Health Care centres which is the first point of visit for any healthcare need

We measure our progress by the number of service uptake in the health facilities in CBHI affiliated with in the rural communities 

The population of Akwa Ibom State is predominately rural and widely dispersed. Health care infrastructure is well organised but sparse and many people have limited access to health care professionals. Therefore our program uses CHWs as local champions to encourage the populace to visit the health facilities for any health need.  The CHWs are trained in resource mobilization and interventions to facilitate discouraging the populace from patronizing quack medical practitioners which increases the mortality and morbidity rate. CBHI will also be involved in developing educational materials to support their interventions that are adapted to specific cultural and tribal practices, which are often extremely localised. Educational resources will also need to reflect the way that gender, age and socio-economic status influences exposure to risk factors. In addition, we will test how best to support CHWs with mobile clinic technology throughout the project. 

In CBHI, we operate a mobile clinic quarterly where we service the underserved communities and also do follow up on clients

CBHI solution does not discriminate against anyone. It is a solution that is inclusive without barrier.

CBHI provide affordable health services to the population of Akwa Ibom State and also identified the indigents to support and ensure that they equally have access to healthcare services. The key beneficiaries are the pregnant women and children under five years. The beneficiaries pay 10, 000naira (24.15USD) to access healthcare services for one year

To sustain the program, the CBHI involve the community leaders in the program and resource mobilization. The community leaders act as the Village Development Committee members. It is also believe that the beneficiaries will enjoy the program and after one year sponsorship continue on their own to re-enroll into the program again.

National Health Insurance Scheme support the financing of pregnant women and children under five premium for the year (21647.62USD).

Philanthropists identify indigents in their communities and finance their enrolment into CBHI (10823.81USD)

Out of Pocket Payment (OOP) (3848.47USD)

Premium (21647.62USD)