Niger Delta region: NDDC, who partnership promises prosperity, optimal healthcare

The Niger Delta region of Nigeria is a disaster-prone area owing to its topographical location and environmental degradation that has continued following decades of oil and gas exploration and exploitation. The region faces unique social and health challenges, including high rates of poverty, restiveness, infectious diseases, poor maternal and child health indicators, and limited access to healthcare facilities. Hence the need for targeted interventions to address these issues, including the strengthening of healthcare infrastructure, training of healthcare workers, and increasing public awareness about preventive health measures. To reverse the situation and accelerate healthcare coverage and financial risk protection for the poor and vulnerable population in the Niger Delta Region towards meeting the Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) by 2030, the Niger Delta Development Commission (NDDC) and the World Health Organisation (WHO) have signed a Memorandum of Understanding (MoU) that will ensure functional primary healthcare centres. CHUKWUMA MUANYA writes on the new partnership.

Experts are unanimous in their agreement that a functional primary healthcare (PHC) system remains the foundation of health in the country’s drive towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) by 2030.

Unfortunately, studies show that many Nigerians have little or no access to quality healthcare they need, especially the poor and vulnerable. This becomes even more challenging for those who live in hard-to reach areas including riverine communities of the Niger Delta.

UHC means that all people have access to a full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

The SDGs, also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity.

The 17 SDGs are integrated—they recognise that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability.

Countries have committed to prioritise progress for those who are furthest behind. The SDGs are designed to end poverty, hunger, Human Immuno-deficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS), and discrimination against women and girls.

Unfortunately, with the increasing double barrel challenge of communicable and non-communicable diseases on the background of health systems deterioration in terms of inadequate healthcare infrastructure, human resource shortages, supply chain issues, and funding gaps, the health seeking behavior of the people continues to worsen.

Investigations show that despite ongoing health financing reforms, out-of-pocket expenditure on health remains high above 70 per cent against the World Health Organisation (WHO) benchmark of 30-40 per cent.

Although the Federal Government’s allocation to health increased to 4.6 per cent in 2024, compared to 4.3 per cent in 2023, with a notable rise in per capita Federal Government budget allocation from $5.5 in 2023 to $7 in 2024, huge gaps and unmet needs exist in the health sector with over 55 per cent of the population falling into poverty due to illness.

Four years Post COVID-19 pandemic, public health emergencies are still ravaging the country with outbreaks of infections such as cholera, Lassa fever, yellow fever and meningitis as well as environmental hazards like poor water sanitation, heavy metal poisoning and urban air pollution.

Several studies have shown that the Niger Delta region of Nigeria is a disaster-prone area due to its geographical location and environmental degradation from decades of oil and gas exploration and exploitation. Although each state in Nigeria is unique, they, however, share similar health challenges with varying degrees of existence and occurrence.

As part of efforts to accelerate healthcare coverage and financial risk protection for the poor and vulnerable population in the Niger Delta Region and towards meeting the UHC and the SDGs by 2030, the Niger Delta Development Commission (NDDC), WHO and the National Social Safety-Net Coordinating Office (NASSCO) have signed a Memorandum of Understanding (MoU) on Sector Wide Approach (SWAp) towards functional primary healthcare system.

According to the MoU, the project will be implemented in three phases: Identify, register, authenticate, and provide credible data of poor and vulnerable people resident in the rural communities of the nine Niger Delta States; enroll one million Niger Delta Citizens into health insurance; and strengthen capacity for health security in the NDDC States while carrying out various operations research and impact evaluation studies to ensure tracking of progress and advancement of learning.

The NDDC is the government organisation mandated to provide lasting solutions to the socio-economic challenges of the nine oil producing States (Abia, Akwa Ibom, Bayelsa, Cross River, Delta, Edo, Imo, Ondo, and Rivers) and to facilitate sustainable human capital development, infrastructure upgrade, economic prosperity, social stability, ecological regeneration, and peace in the region.

This NDDC/WHO Partnership Programme is aligned with the: National Health Sector Renewal Investment Programme (NHSRIP) through the SWAp under the Renewed Hope Agenda as well as the COMPACT signed by the States, Federal Capital Territory Abuja (FCT), and Development Partners; National Development Plan (NDP) 2021-2025; NDDC Regional Master Plan; National Health Insurance Authority (NHIA) Act 2022, that makes Health Insurance compulsory for all residents of Nigeria and further mandates that every resident must first be enrolled into the various State Social Health Insurance Schemes (SSHIS) before participating in any other Health Insurance programme in the country; the National Primary Healthcare Development Agency (NPHCDA) agenda and mandate to ensure the availability of a fully functional Primary Healthcare Service facility in each political Ward across the country; and the United Nations 17 SDGs with special focus on Goals 3 ‘Good Health and Wellbeing’ to achieve UHC by the year 2030 and others including Goal 4 – Quality Education to promote lifelong learning opportunities for all.

According to the MoU, the key outcomes of the programme will be reduced ‘out of pocket payment’ status from the current estimated country-wide figure of over 70 per cent down to below 40 per cent in the nine NDDC states; reduced their Maternal Mortality Rate (MMR) to a two digit figure from the country-wide current estimated three digit figure; improved access to quality healthcare services leveraging on innovations and digitization; and improved health security capacity to detect, notify, and respond to health threats.

The programme will be implemented in three Phases. Phase 1: Identify, Register, Authenticate and provide data to enable enrolment of poor and vulnerable people resident in the rural communities of the nine Niger Delta States. The NDDC and its partner DEHS, will develop a Software system and deploy it across the nine NDDC States for the identification and registration of one million poor and vulnerable people with special focus on Pregnant Women and Children Under five years, into a database that will be authenticated with the National Social Register (NSR) in partnership with NASSCO and the National Identity Number (NIN) in partnership with National Identity Management Commission (NIMC).

The Software system will also be used to assess the functionality status of Primary healthcare facilities in rural communities across the nine states in line with the NPHCDA guidelines and make recommendation for the revitalisation and operationalisation of the defunct and abandoned ones under a PPP programme for quality and affordable healthcare services delivery to the people residing in rural Niger Delta Communities

Phase 2 will comprise the enrolment of one million Niger Delta residents into Health Insurance Schemes. The NDDC and various funding partners will utilise the compliant data generated in Phase 1 for the enrollment the Poor and Vulnerable people into the mandatory National and State health insurance programmes in the states.

A variety of financial risk protection mechanisms for example the NHIA Vulnerable Group Fund (VGF)/Basic Health Care Provision Fund (BHCPF), the State Social Health Insurance Agencies (SSHIAs) Equity Health Fund and the NDDC/Partners Indigent Support Programme (ISP) will be leveraged on to ensure health insurance coverage and access to quality healthcare free at the point of use for poor and vulnerable people resident in the Niger Delta rural communities.

Phase 3 entails knowledge management and health security. The NDDC and the WHO will jointly carry out various operations research and impact evaluation studies to ensure tracking of progress and advancement of knowledge within the life of the programme.

Also, the Niger Delta region is a disaster-prone area owing to its geographical location and environmental degradation from decades of oil and gas exploration and exploitation and this programme will also make provision for disaster preparedness, response, and management systems in collaboration with the NCDC and other National Disaster Management Institutions to ensure effective surveillance and adequate intervention activities.

According to the NDDC, this programme will leverage on the data points of the National Social Register, the Nigeria Population Commission Birth Registration, and the National NIN for an effective “Demand-side” data generation and authentication.

The nine states Social Health Insurance Schemes (SHIS) will leverage on the data generated to improve the population coverage for their Health Insurance Schemes and BHCPF programme among other Social Intervention Programmes.

The programme will also ensure that functional healthcare service facilities are available to the people resident in the hitherto left behind rural communities of the Niger Delta region through the identification, assessment, and upgrade of the defunct and abandoned healthcare facilities in these rural communities, leveraging of the Public Private Partnership (PPP) programme initiative to ensure an adequate ‘Supply-side’ healthcare service delivery where no one will be left behind.

WHO Country Representative, Dr. Walter Kazadi Mulombo, during his recent visit to the NDDC and Rivers State Governor, Siminalayi Fubara, told journalist: “I came to NDDC first to pay a courtesy call. It is the first time I am visiting the NDDC headquarters. I came to finalise a recent memorandum of understanding we signed on intervention in health in Niger Delta, which covers three areas- one is addressing the area of financial protection for the poor and vulnerable; the other one is crashing maternal and child mortality and the third one is prevention, preparedness and response to disease outbreak in the Niger Delta.

“I met the Managing Director and the Chairman of the NDDC board and had opportunity to discuss the ongoing Health outreach programmes and other activities and interventions where they are engaged. At this particular point in time, I think it is a good direction taken by NDDC, especially with the fact that most countries in the world, Nigeria is not an exception, are lagging behind in terms of reaching the target of SDGs by 2030. So, there is a need to work differently and accelerate intervention. Part of what NDDC is doing from what we learn is in that direction, which we are confident and it gives a lot of hope for the Niger Delta to accelerate and meet the SDG target by 2030. It is a collaborative partnership and WHO is happy to partner with any stakeholder that is fast tracking effort to reach all those in need, especially the vulnerable population. The MoU to collaborate with NDDC for this region include a phase to increase the capacity to detecting outbreak and respond to them, just like the recent cholera outbreak.”

He said the visit was to discuss strategic partnerships focused on achieving the SDGs, with a particular emphasis on health as a critical enabler for alleviating poverty among the region’s inhabitants.

Mulombo also reiterated WHO’s commitment to providing continual technical support as guided and powered by the SWAp, which seeks to reduce the hyper fragmentation within the health sector and align development assistance towards impact.

The courtesy visits also allowed Dr. Mulombo to present the 4th Country Cooperation Strategy 2023-2027, which will shape WHO’s intervention strategies in Nigeria and the nine NDDC-focused states, including Rivers.

During a courtesy visit to the Rivers State Governor, Dr Mulombo highlighted the importance of collaborative efforts between international organisations, local governments, and development agencies to address the pressing health challenges facing the Niger Delta Region.

Acknowledging NDDC’s various healthcare interventions to achieve the target for SDGs and ensure that the people enjoy good health and well-being by 2030, Mulombo said: “Nigeria, like most countries of the world, is lagging in terms of reaching the target for SDGs by 2030, thus reason for a global call to do things differently and accelerate the rescue of the people.”

In the visit to the Managing Director, of NDDC, Dr Samuel Ogbuku, the WHO Country Representative emphasised the importance of partnering to address prevalent health challenges in the region, particularly, the issue of climate change and air pollution. The discussions centred on leveraging health initiatives to drive progress across various SDGs, including those related to poverty, education, and economic growth.

Mulombo, in his remark, disclosed: “The NDDC has finalised a partnership agreement with the WHO to accelerate healthcare coverage and financial risk protection for the poor and vulnerable population towards UHC in the Niger Delta Region of Nigeria.

“We note your commitment towards improving primary healthcare services and the revitalisation and drive to improve the health status of the good people of the Region.”

The Rivers State governor reiterated the state’s dedication to achieving the SDGs and acknowledged the critical role of health in this endeavour. The governor pledged that his administration would commit huge budgetary allocations to healthcare in the 2025 budget to drive the activities in the sector.

Fubara said: “We believe that when we roll out that budget, a greater part of the health issues will be accommodated and I believe that by the time you visit us, maybe in another year, the commendation will be there. When we came on board, we also knew that one very important area that we need to touch is healthcare. Development cannot be complete if the health sector is abandoned.”

While the NDDC and Rivers State government were commended for their ongoing efforts to improve the health conditions of the vulnerable population in the Niger Delta, the WHO representative stressed the need for a more integrated approach that places health at the forefront of development strategies.

The Niger Delta faces unique health challenges, including high rates of infectious diseases, poor maternal and child health indicators, and limited access to healthcare facilities.

Mulombo emphasised the need for targeted interventions to address these issues, including the strengthening of healthcare infrastructure, training of healthcare workers, and increasing public awareness about preventive health measures.

During the visits, both the NDDC and the Rivers State government expressed their commitment to partnering with the WHO to enhance health outcomes in the region. The NDDC highlighted its ongoing projects aimed at improving healthcare delivery, such as the construction of health centres and the provision of medical supplies.

Ogbuku, in his remark outlined the health interventions of the NDDC including the NDDC Free Medical Outreach in the nine states of the region. Reiterating the importance of partnership with the WHO, the NDDC boss reaffirmed the Commission’s commitment to take proactive measures to proffer health solutions, on issues such as cholera in the region. He also stated that the commission will provide solar-powered borehole water for communities.

“We are also working on cholera vaccines and commissioning ambulances which we will donate to the nine states of the region,” he said. The visit ended with a call to action for all stakeholders to intensify efforts towards achieving the SDGs, with a particular focus on health. The highlight of the meeting with the NDDC was the commissioning ceremony of 13 ambulances acquired by the NDDC for distribution to hospitals in its nine mandate states by Mulombo alongside other dignities including Ogbuku and Chiedu Ebie, the newly appointed Chairman of the commission.

The NDDC Director, Education, Health and Social Services, Dr. George Uzonwanne, said the goal of the commission was to provide medical services to the people of the Niger Delta region, as part of its mandate.

Uzonwanne told journalists during a free medical mission organised by the commission in Yenogoa, Bayelsa State: “We are here for the continuation of our programmes on medical missions that we started. As you know, the medical missions have been the flagship of NDDC over the past almost 20 years. We stopped them in 2019 due to some budget challenges. The new management thought that this is one of the most important things that the commission does, especially as it addresses the immediate health needs of the poor in the rural communities. For the period, we bring in a team of doctors into the community so that people do not even have to look for money or look for transport or look for any way to into those communities.

“They just come into their own community, walk into the hospital, register themselves and they get treated free of charge. And when I say free of charge, I mean absolutely free of charge. No money taken for cards, registration not for medications. Now the range of services we do starts from as simple as diagnosing malaria to as complex as having Caesarean Section (CS) or doing myomectomies (that is removing fibroids).

“Myomectomy is a surgical procedure to treat uterine fibroids, and tries to preserve fertility using a variety of approaches. We do all these absolutely free by partnering with organisations.

“This programme has been the flagship of the commission and as you know the health indices of a country is very key in describing how much development that country has. Currently our maternal mortality is one of the highest in the world; our infant mortality is also one of the highest in the world. One of the biggest reasons is that people cannot afford healthcare, they barely can eat not to talk of affording healthcare.

“Now we have brought that healthcare to their door step free of charge. We are hoping of making it more sustainable by adding the component of registering people. We are hoping to take a data look at the health indices of the community, poverty indices and social indices in this community and other communities in the Niger Delta so that we use the data to plan for health insurance, plan for education and social services as well.”

On plans to extend this programme to other communities, the NDDC Director said: “As I said, this is one of the short term medical missions; we do plan for more sustainable programme. Recall that the NDDC is not a ministry of health; we still have the ministry doing their work. We are only supporting the ministries of health and I want to use this opportunity to thank the Bayelsa government for letting us use their hospital to treat its indigenes. But we also have other programmes in the healthcare space. This healthcare programme is moving from community to community. As I speak to you right now, we have another team of doctors in Auchi, Edo State.

“Last week we had a team of doctors in Otu-Jeremi in Ughelli South Council, in Delta State. Prior to that, we had a team in Oguta Council of Imo State and another one in Ukana, Essien Udim Council in Akwa Ibom State. We are moving to different places. Next week we have another one. We are going to Ondo State and after Ondo we are going to Abia State. From July 16 to 22, 2024, we had a team in Odukpani, Cross Rive State. June 2 to 8, we had a team in a cottage hospital in Ugu in Okumpolo Iga Council of Rivers State. When we are done with that we repeat hopefully based on the demands or the needs of the communities.”

To actualise the vision and build a viable future for all people of the Niger Delta region irrespective of their socioeconomic status and geographical location, the NDDC has developed a Regional Master Plan. “The new NDDC management is prioritising access to quality healthcare services as a foundational enabler for achieving the full benefit potential of the Master Plan,” Ogbuku said.

Critics say the people of the Niger Delta, need to be healthy to see the benefits of the various solar light projects, move around on the various road projects, benefit from the various education support programmes and participate in the various agricultural support activities of the NDDC.

Over the years, the NDDC has implemented its flagship Community Health Outreach Programmes across the nine NDDC States. Ogbuku said this new programme, will also come in as the continuity and sustainability component for the Health Outreach Programmes by ensuring that the patients are able to have continuity of healthcare services at the accredited healthcare facilities closest to their residence, even after the outreach.