Paula Quigley examines how Universal Health Coverage can be achieved in Northern Nigeria, where the ongoing humanitarian crisis disrupts access to health care for millions of people.
DFID Health Adviser visits Internally Displaced Peoples camp in Yobe State, Nigeria
The Context of Humanitarian Settings
The past few years have been tumultuous in terms of health outcomes. From extensive conflicts in Syria and Iraq, outbreaks of the Zika virus in the Americas, Yellow Fever in Angola and DRC, and cholera in Yemen, and numerous natural disasters, there were many health challenges to tackle.
Addressing these problems requires emergency humanitarian assistance on an ever-increasing scale and detracts from investments in long term health programmes. Yet, more than ever we need strong and resilient health systems that can respond to these diverse challenges, as well as to the rapidly expanding burden of non-communicable disease (NCD), which is occurring all over the world at an alarming rate. Countries or regions can quickly be transformed from stable and safe to insecure and stressed, and can thus easily become areas of fragility and conflict.
There is a clear need for development and humanitarian organisations to work together effectively to ensure that countries can cope with change and achieve universal health coverage despite their multitude of difficulties. The Lancet series on Health in Humanitarian Crises published in June 2017 calls for concerted action on this front.
The Situation in Northern Nigeria
In Northern Nigeria, health services to the regular population are already in short supply. National surveys consistently confirm lower access to essential services and poorer health outcomes in the North.
The situation for Internally Displaced People (IDP), both in camps and in communities, is very difficult. There are around two million IDPs currently in Nigeria, with many of these resulting from the Boko Haram insurgency.
However, it is estimated that 4.4 million people in the North-East are affected by food insecurity and 6 million are in need of healthcare assistance. Yet the health situation is dire, with vastly inadequate supplies of medical personnel, equipment and drugs.
The importance of Women’s Children’s and Adolescents’ Health
In a recent webinar on Women’s, Children’s and Adolescents’ Health in Humanitarian Settings, some of the key challenges raised included the persistent gaps in providing adequate newborn care, family planning and other reproductive health services, and meeting the diverse health needs of adolescents.
The growing importance of non-communicable diseases was noted, as well as the fact that most refugees are not in camps. And unfortunately, violence against women and girls is a daily hazard. It follows that health systems everywhere need to be prepared to meet these needs, not just for their own static populations but for the world’s displaced people who may land on their doorstep.
Our work in the Northern Nigeria region over the past 15 years has been focused around improving the health of women, children and adolescents, and has contributed to the strengthening of local health systems through the extensive achievements of the Partnership for Transforming Health Systems (PATHS) and the Partnership for Reviving Routine Immunisation in Northern Nigeria/Maternal and Child Health (PRRINN/MNCH) programmes.
These programmes operated at multiple levels of the health system, and particularly engaged with local communities to ensure ownership and leadership among Muslim communities, expand access to essential health services, embed a primary health care approach, and establish Young Women’s Support Groups to reach adolescents.
What else are we doing to help?
We are continuing and expanding on these efforts through the Women for Health programme which aims to increase the number and quality of female health workers in Northern Nigeria. An important component is the Foundation Year Programme, a basic access course in which female students are supported to achieve the necessary entry qualifications for the health training institutes so that they can become nurses or midwives. Some of these students have met and befriended young women and girls in IDP Camps and provided health services for them as part of their clinical training. Such initiatives will be critical in expanding access to health services for vulnerable groups in this difficult context.
Our partnership with WISE Development and our work in gender equality strengthens the voice of women throughout this and other programmes. Effects reaching beyond the traditional health system include an impact on gender-based violence.
What more is needed?
Conflicts and displacement are increasingly protracted, therefore humanitarian responses need to be tailored accordingly. Governments need to develop longer term policies and strategies to deal with such situations and health services must be more able to accommodate IDPs.
Lessons from the work of development agencies in contexts of fragility and conflict can be applied to health in humanitarian settings all over the world, as there are many similarities to emergency responses. Through these initiatives we can support the work of humanitarian organisations when the affected regions suffer additional pressures with influxes of migrants.