Rural Health Improvement Program, Nigeria – A Global Health Initiative (A Rural Malaria Control and Primary Healthcare Program) Nigeria – Canada Partnership

Malaria is endemic in Africa, and a child dies every two minutes from Malaria in Africa. Nigeria consistently ranks topmost in the world in malaria prevalence, up to 27% of global statistics. Children and pregnant women living in rural Nigeria are most vulnerable to malaria and its adverse outcomes. Malaria complications (including maternal and child death) can be effectively prevented and treated in a primary health care setting. Unfortunately, most rural Nigerians do not have access to essential primary health care services, and poverty is a huge barrier.

The cornerstone of global health initiatives is health equity, and the Rural Health Improvement Program (RHIP), Nigeria is a Global Health Initiative. RHIP Nigeria aims to save and improve the lives and hope of rural Nigerians through effective malaria control and primary health care programs that are free and easily accessed by patients. RHIP Nigeria is a healthcare partnership between Nigerian communities and Canadian organizations led by Dr. Odoh Onuora. The program was co-created, and implemented collaboratively with the host communities, and approved by the Nigerian government. RHIP Nigeria started in 2019 as a malaria control project titled Say-No-To-Malaria in Amechi Uwani and was funded by the Rural Coordination Centre of British Columbia, as a Rural Global Health Partnership Initiative. Like many other rural Nigerian communities, the Amechi Uwani community has no government primary health centre. The successful outcomes and lessons from the Say-No-Malaria project led to the project’s transition to a robust, comprehensive primary care program, building a modern health clinic and establishing a registered charity organization (Oasis Community Health Foundation) in 2021.

RHIP Nigeria is part of the global primary health care program of the Pacific Northwest Division of Family Practice (PNWDoFP).  PNWDoFP is instrumental in the development, implementation, and funding of the program. RHIP Nigeria collaborates with the Department of Global Health, the University of British Columbia (UBC) and the Global Health Committee of the Society of Rural Physician Canada (SRPC).

Say-No-To-Malaria is an innovative approach to malaria control through effective malaria prevention (education and chemoprophylaxis), early diagnosis (microscopic testing), appropriate, timely treatment (using artemisinin-combination therapy; ACT), resulting in zero complications and no deaths through this rural health initiative. Trained community youths visited homes in Amechi Uwani community every three months to provide malaria education and administer appropriate chemotherapeutic doses of sulphadoxine-pyrimethamine to children under the age of five years and pregnant women. At each visit, parents are counselled to take any child that in future develops a fever or is suspected of having malaria to the RHIP Diagnostic and Treatment Centre for appropriate diagnosis and treatment. If the test confirms malaria in a patient, the first dose of recommended anti-malaria (ACT) is given at the centre, and the remaining doses are dispensed to the parents.  Acetaminophen is dispensed to the parents during a home visit to keep at home and give to any child that develops a fever, while an arrangement to visit the Diagnostic and Treatment Center for proper diagnosis and treatment is made to prevent seizure; a common complication of malaria. There were four home visits in the first year to each household.  An evaluation of the program showed significant results:   a 54% decrease in malaria incidence, no malaria complications, and zero malaria deaths. The cost of the four chemoprophylaxis received by each patient over the four visits in a year was 84% less than the cost of treating a single episode of malaria case.  100% of the participants responded that their malaria knowledge was improved and wanted the program to continue.

RHIP Nigeria’s scope and the practice expanded after the first year with the building of a medical clinic in the Amechi Uwani community. The clinic opens on weekdays and is staffed with a medical doctor, nurse, laboratory technician, a manager and others. The clinic provides medical consultation, laboratory services and medications to patients of all age groups at no cost. The clinic is powered by a solar electricity source and has a reliable water source, security cameras and internet service. The clinic has a website and hopes to transition to electronic medical record documentation as funds become available to support that.

The current scope of RHIP services includes: chronic medical disease management (diabetes mellitus, hypertension,  chronic cardiac and respiratory disease, chronic pain etc.), acute disease care (malaria, respiratory infection, diarrhea, skin diseases, typhoid fever,  prenatal care etc.),  school health program (dental care, deworming, etc.), community outreach to communities within and outside of the state,  community dental care program, community eye care program, student internship program, and research.

RHIP Nigeria has saved many lives and improved others since its establishment in 2019.  Rural communities in Nigeria are very grateful to the services RHIP Nigeria provides and hope the program becomes permanent.  The RHIP Nigeria team is working hard to sustain the program and is currently seeking grants, donations, and other support.

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