Charles Chukwuma Soludo, economics professor and former governor of the Central Bank of Nigeria, is the new governor of my homeland, Anambra State, South-East Nigeria. For Soludo to excel, he should make healthcare the centrepiece of his administration.
Health indices in Anambra are not encouraging: HIV prevalence rate of 2.7 percent (national average is 1.4%); 3,718 women of reproductive age die every year from pregnancy and childbirth complications, and 12 percent of under-five children are stunted.
These inequities must end. Below are five ways Soludo could achieve that:
Mainstream healthcare into every state policy
In 2018, I gave my first TEDx Talk, “without health, we have nothing.” COVID-19 has shown why this is true. As Soludo begins to review existing policies and come up with new ones, one question should be uppermost in his mind – how does each policy help Anambra achieve quality healthcare for its residents?
He has already met with the state security team to begin addressing the insecurity in the state. Mainstreaming health in security policies implies exploring how insecurity has negatively impacted the health of the residents and how addressing it would ensure better health for our people. Without a doubt, in the midst of the current insecurity, people would have died or now live with health complications because they could not be conveyed to health facilities for fear of being attacked by bandits.
Another example of mainstreaming health in state policies is ensuring that schools must feed children with at least one nutritious meal per day. This would help reduce stunting and wasting in children. It would also increase school enrolment, retention and completion.
Prioritise social determinants of health
It is noteworthy that one of Soludo’s first acts as governor was embarking on a visit to Okpoko, Ogbaru Local Government Area, the state’s worst urban slum. He promised to begin his urban renewal efforts there. This is commendable. He should go further to make prioritisation of social determinants of health the mainstay of improving the health of residents of the state.
Healthcare planning and delivery are suboptimal without social determinants of health. For instance, clean water is an important social determinant of health. It helps in prevention of infectious diseases, including Covid-19.
Likewise, physical activity improves health and quality of life. Achieving these requires better urban planning by designating walkways and bike paths on existing and new roads. When more people are physically active, the incidence of non communicable diseases such as hypertension, diabetes and kidney diseases would fall. For starters, it would be good to have a monthly car-free day in Awka, the state capital, to inspire walking and biking.
Mobilise residents to sign up to mandatory state health insurance scheme
Less than 5 percent of residents of Anambra State have any form of health insurance. Lack of health insurance pushes families to impoverishing catastrophic spending on healthcare. This is unsustainable and inequitable, especially for low-income groups. To achieve equity in healthcare, we must achieve equity in health education, according to the University of Global Health Equity, Rwanda.
Therefore, when it comes to enrolling all Anambra residents for the mandatory health insurance scheme, it should not be business as usual. Soludo should direct the state health insurance agency to use every means necessary to take the message to people directly. This includes all traders at markets, bus/taxi drivers in parks; town unions; religious institutions; schools; and on social media. People already spend so much as out-of-pocket expenditure to pay for healthcare. They need to know that a fraction of that can buy health insurance for them and their families.
Revamp primary healthcare
According to the World Health Organisation, 80-90 percent of the healthcare needs of an individual throughout the person’s lifetime can be provided at the primary healthcare level. A major hindrance to improving primary healthcare in Anambra State is non-functional local government councils.
Already, Soludo has made the conduct of local council elections a major priority of his administration, “We will conduct LGA elections. No doubt, the uniform local government system as the third federating unit is one of the contested features of our federalism,” he said. Constitutionally, health is on the concurrent list and provision of primary healthcare is within the purview of local councils in Nigeria. While we wait for the local council elections to take place, he must work with the existing local council leadership to revamp primary health care delivery. Under-five children in Anambra State should not keep dying from diarrhoea because of poor governance at the local council levels.
Other components of primary healthcare include health education; vaccinations, nutrition, maternal and child healthcare; safe water supply and basic sanitation; local endemic diseases control; appropriate treatment of common diseases and injuries, and provision of essential basic medication.
Make emergency ambulance service work
It is mind-boggling that no state in Nigeria has a functional ambulance service. Sadly, Nigerians have come to associate ambulances for conveying corpses more than people during health emergencies.
How are we able to use hailing apps such as Uber and Bolt to order for taxis yet scramble to convey a pregnant woman who is in labour and bleeding profusely to the nearest health facility?
During my time as the chief executive officer of EpiAFRIC (an Abuja-based public health consultancy group), I led seven hackathons in Nigeria, Kenya and South Africa, from 2017 to 2021.
The team that won our first hackathon in Lagos, created an app for ambulance services called SWIFT EC. The Uber-like app has the potential to change the ambulance landscape in Nigeria. Soludo should ensure that health tech firms are encouraged to participate in the planned Anambra State technology park.
A healthy Anambra is a wealthy Anambra. Soludo has a good opportunity to make the people of Anambra wealthier. Quality healthcare for all is a good place to begin.
Nsofor is a Senior New Voices Fellow at the Aspen Institute
