Table of Contents
By Pharmacist Opara Augusta Onyinyechi
Introduction
The Crisis in Healthcare Access
Every day across Nigeria, many people well within their active life years die not because of accidents, wars, or natural disasters but due to preventable health conditions. Some of these conditions include complications from unmanaged chronic disease, such as diabetes, hypertension, or even undetected heart conditions. Recently, there has been a surge in slump-and-die incidents. This term has become very relatable to the average Nigerian because of its widespread popularity. A very well-known case is that of a young TikTokker who died on a livestream in what appeared to be an active stroke episode. Or it is the wrestler that died in Ghana, or the wealthy hotelier that died during his wife’s birthday, Thanksgiving service, the list is endless.
All these deaths and cases have been attributed in part to a lack of healthcare access or the overall poor health-seeking behaviours of the average Nigerian. According to an article by BusinessDay Intelligence, Nigeria has 38,824 operational healthcare facilities that serve a staggering 235 million citizens. That’s one hospital or clinic for every 5,900 Nigerians. This paints a vivid picture of what ordinary citizens face when accessing healthcare.
Healthcare Access Crisis in Rural Nigeria
While healthcare access is a big issue in Nigeria, what is more disturbing is that many citizens are tucked away in the heart of Nigeria, in the countryside and villages. These people do not just battle the economic hardship in the country; they also battle diseases that ordinarily should not be a death sentence. Deaths due to malaria should no longer be heard of, nor women dying from pregnancy complications, nor children developing preventable health conditions due to a lack of vaccines. But these and more are what people in rural Nigeria still battle with, and this can be traced to a lack of primary healthcare facilities and healthcare workers in these regions. According to World Bank data, in 2023 alone, 45.72% of the Nigerian population—102,321,360 of the total population of 223,800,000—lived in rural settlements. Within this population, the Nigerian Primary Health Care Development Agency (NPHCDA) reports that 60% of the rural population lacks access to primary healthcare. This is not just unsettling but calls for massive intervention and a focus on this population, which seems forgotten and excluded from recent healthcare innovations.
E-Health Intervention
To address Nigeria’s health access issues and the shortage of healthcare professionals, e-health clinics were introduced, enabling citizens to access healthcare without visiting a physical facility. Still, they can book an appointment and talk to a doctor by phone, voice, video, or text. Studies have confirmed that this innovation has since improved healthcare access among Nigerians. The convenience and ease of accessing a healthcare professional by phone are among the factors enabling its widespread adoption. However, what about people living in rural areas who have no access to an internet-enabled mobile device, live in areas with poor internet connectivity, or lack the necessary tech savviness to use such technology? How has this innovation impacted their lives? How can we further develop this innovation to make it more inclusive, especially for people living in rural Nigeria who lack primary healthcare facilities and will therefore benefit more from this technology?
The e-Health-based Community Model
Therefore, to address the limitations of e-health and ensure inclusive coverage, this model was developed after extensive thought and research into what does and does not work. Though this is an innovative project and will be piloted soon to monitor its performance, this was developed to target underserved populations in Nigeria especially older people, those in the rural communities with a lack of access to healthcare facility, areas with shortage of healthcare professionals and people who cannot afford an internet enabled mobile device or lack basic knowledge to operate an e-health app. The model will include training selected members of a given society in the use of an e-health app and vital signs monitoring devices. They will be given a health kit containing devices for vital sign monitoring and an internet-enabled tablet for a video call meeting between the patient and doctor to ensure open communication and expression. The model will be based on subscription to ensure sustainability, but subscriptions will be subsidised to ensure broad participation. The various components of the model will include:
Training of Volunteers in The Use of Digital Health Applications
Due to a workforce shortage in the healthcare system, ordinary people will be recruited and trained for this program. They will be trained to use the BP monitoring device, thermometer, and glucometer to record patients’ vital signs and enter them in the e-health app for the doctor. These volunteers will be recruited from within the community to foster interaction in the local language and enhance active participation from the community members. To ensure professionalism and authenticity, these volunteers will receive a certificate of training completion, confirming their certification, as well as a uniform. These volunteers will then move into communities and recruit community members to participate in the program. The number of volunteers in a community depends on community participation.
Involvement of Doctors In the Digital Health Program
Doctors will be recruited and registered for the programme. Qualified doctors will register using their licence number to ensure only qualified doctors are recruited for the programme. Doctors across various fields and qualifications will be recruited, ranging from medical officers, resident doctors, and consultants, based on their interest in joining the program. Also, the opportunity will be opened to doctors in the diaspora who indicate interest. These doctors can log their availability in the app, and they will be matched to a patient based on it. To ensure that the few medical personnel available can go round, the consultation session will be timed to 30 minutes. They will consult the vital signs records uploaded by the volunteers and the information provided by the participants. Doctors will be assigned to patients based on their ability to understand and speak in the language the participant is fluent in, as recorded by the volunteer. Doctors will be assigned automatically by the app using algorithms.
Sustainability of the E-Health Model
Since the program is not government-sponsored, sustainability measures will be put in place to ensure continuity and to reward volunteers and doctors. Although the ultimate goal is to improve healthcare access, participation will be based on a monthly subscription of 3,000 naira, with 1,000 for equipment and app maintenance, 1,000 for volunteers, and 1,000 for the doctor. This means that for every participant the volunteers register, they receive 1,000 naira, and for every patient the doctors see, they receive 1,000 naira. This fee will be remitted to them at the end of the month based on the total number of patients they see. This subscription fee of 3000 naira will allow participants to check their blood pressure, temperature, and pulse 4 times a month, check their blood sugar level 2 times a month, and see the doctor 2 times a month. This is to ensure that healthcare professionals are available enough to go around and that medical supplies are readily available. Medical supplies will be replenished monthly based on the number of registered participants in a location. The activities of the volunteers will be monitored by the app and by regional coordinators to ensure transparency.
Infrastructural Needs of The E-Health Model
The following equipment will be utilised in the program. This equipment will be stored and carried in a customised health kit. This equipment will include:
Digital BP monitor that records blood pressure and pulse
Glucometer
thermometer
Internet-enabled tablet device
A router for internet connectivity
stationaries
Possible Limitations of The E-Health Model
Massive awareness programs will address cultural and belief barriers among the participants.
Lack of Transparency issues from Volunteers, which can be curtailed via the app and the use of regional coordinators
internet connectivity in some areas, which can be curtailed using advanced internet connectivity, such as a satellite dish or a universal router
Conclusion
One’s income or place of residence shouldn’t be a barrier to receiving high-quality healthcare. Urban areas have benefited from technological advancements, but far too many Nigerians in rural areas are still caught in a cycle of avoidable disease and delayed diagnosis. Bringing healthcare to people’s doorsteps through skilled volunteers, intelligent tools, and the power of connection is a straightforward but potent prospect presented by the e-health-based community model. This is a call to action, not just an idea. This paradigm may ensure that no Nigerian is left behind in the pursuit of health equity through effective collaborations, public support, and a commitment to inclusivity. Now is the moment to take action before another person dies from a preventable illness.
2 comments
Your point of view caught my eye and was very interesting. Thanks. I have a question for you.
Yes, please