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Primary Care Clinic – Nigeria

July 22, 2008
By Sope Ogunyemi

Overview

We are refocusing the Nigeria project and exploring establishing the first clinic at a new site, in the Aguda neighborhood in Lagos, Nigeria. The area is a good potential site because it is a densely populated, low income area with no access to primary health care. Also, the neighborhood is located within the city of Lagos, allowing for ease in logistical planning and execution for the free clinic.

The population to be served is approximately 100,000. Most of the residents are predominately poor and few would classify as low income earners. It is a high density area and most homes are rented one or two room apartments, with dilapidated infrastructure, badly ventilated rooms, poor sanitary conditions and no pipe borne water. The area would greatly benefit from complimentary basic health care, as it does not have any such facility. Current remedies in the area are either non-medical or out of price range for the local residents.

We are extremely excited to have identified an on-ground NGO partner, Afodise, to take over the long term management of the Nigeria clinic, with the hope of establishing multiple centers across Nigeria. Afodise has already established health care clinics in low-income areas in other parts of Nigeria. See below for more information on Afodise.

We are working to establish the facility as soon as possible and estimate that the time to launch the clinic will be 6 months, or January 2009. Real Medicine Nigeria Project Director will be visiting potential sites and meeting with partners in Lagos during August/September 2008.

Project Status

• Name of Clinic: TBD
• Type: Primary Healthcare Center will provide Basic Health Services. The clinic will be established as a "Build, Operate and Transfer" facility (BOT). Real Medicine Foundation will establish the clinic and transfer the running to a local Non-government organization Afodise, in partnership with the Lagos State Government, for long-term management.
• Partnerships
  1. Lagos State Ministry of Health: RMF Board Member, Dr. Ogunyemi, has secured commitment from the Honourable Commissioner of Health, Lagos State, Dr. Jide Idris, to support the clinic, by providing free medication. Additional Support TBD
  2. AFODISE (African Foundation for Development of Infrastructure and Social Services in Rural Communities) is a non-governmental, not-for-profit, non-political, organisation formally registered with the Nigerian Corporate Affairs Commission. The organization began operating as a family charity in 1955 and focuses on sustainable development of basic infrastructure and social service in rural communities. AFODISE currently serves as one of the United Nations Development Program (UNDP)'s Implementing Agents for Akwa Ibom State, and represents NGOs/CBOs on the UNDP/State Trust Fund and the State Project Consultative Committee (SPCC) of the UNDP. AFODISE has also facilitated the establishment of a Health Center by the Akwa Ibom State Government (in Oboetim Nsit), commissioned in 1995, and which currently caters for the needs of the village and its environs.
• Next Steps:
  We are currently working with our partners to reach out to Aguda community leaders for support and to secure a building for the clinic. More updates to come soon.

Restoration of the Free Clinic for Children in the Makoko Slum, Lagos, Nigeria

Update: January, 2008
by Dr. Deji Shedu

• CHSS received certificate of incorporation from the CAC in August
• Dr. Osin Sunday & Dr. Dotun Ogunyemi - two RMF volunteers visited Lagos in December:
• Dr. Sunday met with our team on ground, held discussions on RMF accounting system and took some pictures of the proposed site for the clinic
• Dr. Ogunyemi discussed the framework of the project with our team members. He also met with the Lagos State Commissioner for Health
• The Commissioner expressed interest in our project and seconded Dr. Jagun from the ministry to help us on the project.
• He also invited us to take part in the various health programs organized by the state
• These include: Malarial program, TB program and the Vaccination program

Update: September, 2007
by Dr. Deji Shedu

• We finally located and had audience with the ruler and authentic head of the community
• We received the letter of invitation into the community
• CHSS has finally been incorporated as an NGO
• The community has donated a plot of land for the clinic
• We already scheduled a meeting with all of Makoko Community for Saturday September 30th, 2007.

Update: May, 2007
by Dr. Deji Shedu

It's "Hurrah" for Team Nigeria in April, as the Federal Ministry of Health supported our application for the registration of Complete Health Support Services (CHSS) - the representative of RMF in Nigeria. To see the approval letter, please click here.

We are also fortunate to have secured the services of a Project Coordinator, who will organize our efforts on this project on site. The Project Coordinator understands the local language, she is familiar with the area our project is sited and is passionate about working with the community. She will be responsible for reaching out to the community through its leaders and to bridge the gap between the host community and RMF. Furthermore, she will be involved in day to day activities associated with setting up the clinic, including arranging for staffing, and account keeping, as well as other duties that may come up.

Update: December, 2006
by Nkem Ndionuka

We met with the community leaders and introduced them to the proposal of RMF.

As expected, it was a great occasion for them which was evidenced in the warm reception accorded us. It was really really great! In the company of Mrs. Balogun we kept an earlier appointment and for about 3 hours had discussions and interactions after which we arrived with the following:

• 1.The makoko community is highly delighted about the news of RMF.
• 2. The community is in dire need of such projects for which RMF is known.
• 3.The community is ready to partner with RMF by providing a place for the clinic's location.
• 4.The community comprises of people from neighbouring countries like Togo, Benin Republic, Ghana and Cameroon whose only source of livlihood is subsistence fishing.
• 5.The only standard healthcare services are provided by a little clinic run by the Catholic Church, although attendance is poor due to costs.

Update: October 4th, 2006

The project Restoration of the Free Clinic for Children in the Makoko Slum, Lagos, Nigeria is starting to gain momentum.We have attracted the interest of Dr. Nkem Ndionuka of Nigeria, Ms. Pei-hsuan Tsai, a nurse in Cambridge, MA, and Mrs. Bukky Balogun, a lawyer working with the Lagos State Ministry of Justice, who are also enthusiastic to see the project come alive. Dr. Nkem and Mrs. Bukky will be visiting the Makoko slum's elders, to introduce the plan and hope to receive their whole-hearted welcome to bring such a life saving service to the community's children. Dr. Nkem is gathering accurate estimates of material costs for the proposal's budget, as a final critical step before the proposal is submitted for funding to various sources.

Ayodeji (Deji) Shedu MD, MPH, June 14, 2006

Background:
Makoko is a teeming shantytown in Lagos State. It has an estimated population of 50,000 people, the majority of who live in wooden huts built on stilts sunk into the dark waters of the Lagos lagoon. Makoko waterside inhabitants are mainly fishermen, who go out to fish in the night and stay indoors during the day, while the women take the fish to sell in the market or to dry. The maximum family income is about $50 dollars a month. The vast majority lives on less than $1 a day. They are mainly of the Ijaw and Egun ethnic stock. The adjoining mainland is inhabited by people from other ethnic groups with similar socioeconomic status.

The social infrastructure in Makoko is very poor. The mainland does not have good roads, the area lacks potable water and the waterside is devoid of a sewage disposal system. This results in high morbidity from malaria, diarrhea and other infectious diseases. To reduce the high morbidity and mortality, medical volunteers in conjunction with the Nigerian Red Cross organized a free clinic for children under the age of five years in 2001. This clinic also provided care for the children in the motherless babies’ home being run by the Nigerian Red Cross in the area. The clinic was shut down the following year because of lack of support from other stakeholders.

Plan:
Provision of adequate health care to the inhabitants of this deprived section of the Lagos metropolis will be three stages.

1st Stage: Restoration of free pediatric services to children under 5years and provision of same to children aged 5 - 11. Duration: 2 years.

2nd Stage: Enlargement of health services to include older children (up to 18 years) and also provision of maternal health services. Duration: 2 years.

3rd Stage: Provision of expanded primary health services to include acute and chronic medical services to adults.

The services of the maternal aspect of the second stage and the third stage will be paid for. The goal is that by reaching the third stage, the health facility will be self sustaining. This proposal is focused on the first stage of the plan.

Goal:
To restore free pediatric care services to the estimated 15,000 children under the age of 12 years (primary school age) in this Lagos slum.

Objectives:

• To improve the access to health care for the pediatric population.
• Provide a standard package of primary health care for the target group, incorporating health education to mothers, disease prevention and health promotion.
• To involve the local community in the health care delivery system, thereby ensuring acceptance of the clinic at the grassroots.
• To train health workers who are interested in working with the underserved urban population, especially in the areas of health education and promotion.
• To collect demographic and health related data of this population and their analysis to improve understanding of their health needs.

Components:
A) Restoring the free clinic for children

• Provision of a health center in the area: This health center will replace the two room facility that was used in the previous attempt to provide services. A building with the best location, adequate number of rooms and standard facilities will be leased for the first phase of the project. Ideally it should accommodate an Out Patient Department, nursing station, doctor’s office, call room, nursing room, treatment room, dispensary, storage and ward of four beds.
• Staffing: The following staff will be hired to accomplish the stated objectives of this project.
  1. A full-time medical doctor who has at least 5 years of independent practice in pediatrics or general medicine with pediatric care experience
  2. Two full-time nurses experienced in pediatric care
  3. Four full-time, experienced nursing assistants
  4. One experienced, part time laboratory technician
  5. One part-time public health practitioner
  6. One part–time cleaner
  7. One full-time watchman
• Drugs
• Equipment

B) Disease Prevention:
The public health practitioner will lead and coordinate the activities of the nurses, nursing assistants and trainees to assess the vaccination status of children especially those in the waterside (according to the National Program on Immunization schedule) through a hut to hut survey. Not yet immunized children will be vaccinated and data will be collected to determine why these children had not been vaccinated. Data will also be collected on the ailments and medical problems that commonly affect this population.

C) Implementation Strategy:
The Real Medicine Foundation, through Comprehensive Health Support Service, will have direct administrative control over the clinic and other public health programs. These programs will be run in accordance with national and state health programs. Community involvement and participation will be a cardinal tenet in the execution of this project to ensure acceptance and sustainability.

1. Up to two part time doctors may be employed as the need arises.
2. The project will start with 2 nurses and this number will be increased to a maximum of four if there is need.
3. Two additional nursing assistants may be employed if the need arises. Up to four nursing assistant trainees will also be hired. Rigorous attempts will be made to hire qualified and motivated personnel from the community, especially those from the waterside.
4. Public health practitioner will coordinate outreach health promotion and health education services to inhabitants of waterside and the adjacent mainland. He / She will also be responsible for data collection and collation.