Ogbonge public health sabinus wey be our oga for TalkHealth9ja, Dr. Laz Ude Eze talk say every community must have a Health Committee if they wan develop sharperly. He talk dis one inside Umuahia as a guest speaker during di Nkporo National Youth Summit.
Dr. Eze talk say na when communities dey involved inside health matter, e go make people dey kajad, live longer and happier. He say village or community health committees go help for health promotion, make environment clean and stop make pregnant women and pikins from dying anyhow like fowl. He gave big tuale to Nkporo people for di topic “PUBLIC HEALTH AND COMMUNITY DEVELOPMENT” wey he talked on for di event.
See di full speech. Warning, e long like palm tree and grammar brekete inside am o.
PUBLIC HEALTH AND COMMUNITY DEVELOPMENT
I grew up in Okposi, Ohaozara Local Government Area of Imo State in the 80s, Abia State in the early 90s and currently in Ebonyi State. Though rapidly urbanizing at the moment, it was a very rural community without electricity, potable water, good roads, or even good health facilities. The main source of water were streams, spring and river, with people bathing and washing at one section and also fetching it for domestic activities in another section of same water body. Hand pump boreholes were very few and waterborne diseases including guinea worm was endemic.
I was fortunate that I was not falling ill very often, but I recall that the few times I fell ill, I was never taken to a health centre or a hospital. My mother would take me to a “nurse” who would give me injections, or I would go to a patent medicine dealer (chemist) and they would mix drugs for me. In one occasion when I had a scorpion sting on my finger, she urinated into a nylon bag and asked me to put the finger inside of it. Till date, I still don’t know the essence of the “urine therapy”. But this goes to show the extent our people go to seek self-help in taking care of their health when public health is largely dysfunctional or not in existence. How is this related to the topic of discussion? You would find out shortly.
As I proceed, I think it is pertinent to explain the terms of this subject of discussion. What is Health? According to the World Health Organisation (WHO), Health is a state of complete physical, mental and social wellbeing and not merely the absence of diseases or infirmity. What then is public health? In simple terms, public health refers to the health of a population of people. According to the American Public Health Association, public health promotes and protects the health of people and the communities where they live, learn, work and play. Is there a difference between a medical doctor and a public health professional? Of course yes, a medical doctor is primarily trained to diagnose and treat individual people who are sick, while a public health professional is trained to prevent people from getting sick or injured in the first place, and to manage systems that will ensure they get quality healthcare when they eventually fall ill.
Furthermore, the Centre for Disease Control (CDC) Foundation describes public health as “the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world. Public health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research—in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured. Public health also works to limit health disparities. A large part of public health is promoting health care equity, quality and accessibility.”
What then is community development? The United Nations defines community development as “a process where community members come together to take collective action and generate solutions to common problems”. This is quite explicit. What then is the nexus between public health and community development? The wellbeing of any community depends on the state of their health. “Health is Wealth” is a common cliché but also a truism. A healthy community is a wealthy and happy community. Community medicine, a component of public health focuses largely on maintaining the health of a specific community using public health approach. Therefore, there is a direct correlation between public health and sustainable community development.
I gained the understanding of public health during my 4th year at the University of Ibadan (in 2006) when we visited occupational health sites, abattoirs, local government health departments and markets as part of our community medicine course. I could relate the quality of life in some Ibadan communities (Oyo State) to the effectiveness of the public health institutions. I could point the difference with what was obtainable in Okposi – my own community, and why many of our people died from highly preventable and curable diseases. Determined to use public health to drive community development, I had my postgraduate trainings in public health policy and management.
How can you leverage on public health principles and strategies to drive the development of Nkporo community? It is both simple and complex. It’s simple because it is doable and achievable, and Nkporo people has over the years taken charge of their destiny and doing massive things. It is complex because it is not a dash but a marathon, sustainability of the gains made requires management of human complexities, sustenance of dedication, resource flow and among other things. A community is made up of the ala (land) and mmadu (the people). Sustainable development focuses on the people, who would eventually develop the land. Let me now outline four major and very important practical steps through which ndi Nkporo can take to develop the community through public health.
The single most important step to driving community development through public health is the Establishment of Community Governance Structures for Health. The National Health Act 2014 created the Ward Health System (Section 1 and 2). It is made up of Village Health Committees, Community Health Committees and the Ward Health/Development Committees. The Nkporo community should set up a health committee. Being a very effective organ of development in Nkporo land, the age grade system can also be used to drive public health and community development. Members of the health committee shall include a well-respected person elected by the committee members to serve as Chairman, an elected literate member of the Village to serve as Secretary, a representative each of religious groups, women’s groups/associations, occupational/professional groups, NGOs and the officer-in-charge of the health centre, if available. Membership of the committee also includes a representative of persons living with disabilities, traditional healers and patent medicine vendors. A trusted member shall serve as Treasurer. Details of the composition, roles and responsibilities of the community governance structures for health can be found in Chapter 2 of the Ward Health System (2018) – a primary health policy of the National Primary Health Care Development Agency. The Nkporo Community Health Committee (NCHC) shall facilitate the forming of health committees by every village. Chairpersons of the Village Health Committees shall also be members of the NCHC.
The second step is a comprehensive baseline assessment of the state of health in Nkporo. Primary Health Care is not just about the PHC buildings but has a huge community component. Social determinants of the health of Nkporo people include level of education, economic stability, traditional practices, food, transportation, etc. How these influence the state of public health of the community may be determined through this assessment. A team of public health professionals and community leaders should lead this exercise and must be done scientifically. Recall the story about the state of health and development of Okposi in the 90s, it is possible some parts of Nkporo may be in a similar situation. This assessment identifies the extent of the problems in specific terms and would identify potential bottlenecks to solving them. The Make Our Hospital Work campaign implemented this step on the Okposi General Hospital and it inspired a lot of community actions including the formation of a community health committee.
Using the baseline assessment report, the third important step should be the development of Nkporo Community Health Development Plan (2022-2026). This strategic plan shall provide a roadmap and outline activities the community shall embark on to resolve the problems identified in the baseline assessment in a sustainable manner. It should also include implementation strategies, roles and responsibilities of various community governance structures and institutions as well as the budget estimates.
The fourth step is the implementation of the strategic health development plan. This will involve resource mobilisation, monitoring, supervision and evaluation. This implementation should be driven by the NCHC with the active participation of the Nkporo people. Another plan may be developed for 2026 to 2030, and thereafter.
In conclusion, health is not a standalone discipline. It is everything. Every aspect of our life impacts on our health and the state of the people’s health also impacts on every aspect of life and development of the community. Health is not just a social service or a charitable venture, health is a business, it is a security matter, a spiritual matter, a cultural matter, and it is our life. For any community to develop sustainably, it must put public health first. What are you waiting for? Nkporo people are brilliant, innovative, influential and strong. Let’s swing into action and make our hospitals work. Let Nkporo show Abia, Nigeria and the world the very positive example. Oruola na omume!
Dr. Laz Ude Eze is a public health physician, health policy and management expert and sustainable development consultant. He’s the Founder of TalkHealth9ja and Convener of the Make Our Hospital Work campaign. This piece was his presentation at the Nkporo National Youth Summit, Abia State made on 24th September 2021.