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By: AMAWU, Cletus Albert Amawu.
Media Volunteer, Nigerian Red Cross Society (NRCS),
Cross River State Branch.
The UN Refugee Agency and Nigerian Red Cross Society, Cross River State Branch, paid a courtesy visit to the Cross River State Commissioner for Health, Dr. Henry Egbe Ayuk, in his office for familiarisation, to further strengthen the working relationship to improve public health services delivery, as the State account for about 56% of Refugee population.
Dr. Henry Egbe Ayuk welcomed the Team and apologised that, if he had known of the enormous projects executed by the UN Refugee Agency, the scope of the meeting would have been enlarged, or better still, the Team would have been invited to participate in the just concluded, International Business Engagement with foreign partners.
“I sincerely want to welcome you on behalf of the Governor, Senator (Prince) Bassey Otu, and the Ministry of Health. Haven listened to all you’ve done, and to be honest, if I knew the scope was this massive, we should have expanded the meeting to accommodate more stakeholders, because more Ministries would be involved. We need a lot of collaboration and partnership.
“On this note, I will facilitate a meeting with His Excellency shortly with your country representatives, so that we can come together to discuss key areas and see how we can achieve the governor’s target in health to achieve Universal Health Coverage, to actualise Governor Otu’s “Partnership: A New Paradigm Shift,” mantra.
Health system strengthening will always create a window in the Public Health System to make way for innovation.
“I want to request documents for all you’ve done especially, that of the Ambulance. Hence, no record at my disposal to this effect. So much has been done, but with little reportage, so, we also require, Data sharing to avoid duplications and leakages, to synergise and monitor how monies are disbursed and medications dispensed at the Primary Health Centres for checks and balances, especially in the areas of retirement.
“Let me also commend your Insurance scheme proposed model, it’s quite noble and the Ministry of Health will carefully study it and make recommendations to the governor, This will get the Primary Health Care Development Agency and the State Health Insurance Agency involved,” he said.
Speaking earlier, the leader of the delegation and Head of the Calabar Field Office, Mr. Mohammed Nafion, congratulated Dr. Ayuk on his appointment as Commissioner for Health and assured him of collaboration to better the lives of Refugees and host communities. He thanked the Commissioner for granting an audience to the UNHCR and Nigerian Red Cross, within short notice. “Cross River State is quite dear to the UN Refugee Agency, because shooting the largest number of Refugees in Nigeria, accounting for about 56% of the national Refugee population in Nigeria,” and delegated his colleague, Dr. Ernest Afu Ochang, the Public Health Lead in Nigeria, to further brief him on what the UN Refugee Agency has done together with their Health partner, the Nigerian Red Cross Society (NRCS).
Dr. Ochang appreciated the opportunity given to him to further brief the Honourable Commissioner on what the UNHCR has achieved and intends to do. I want to thank my Head of Office, he’s a man of very few words and a man of action.
“The UNHCR is the UN Agency responsible for Refugees globally. Our coming is to let you know that, Cross River State has been very benevolent to refugees and has opened its hands to receive and host refugees. In Cross River alone, we’re hosting over 56,000 out of a total of 99,000 thousand refugees in Nigeria, and 87,000 are Cameroonian Refugees, and they’re our brothers and sisters, who have found solace in Nigeria as a result of the agitations by the Abazonia separatist movement in the Southern-English speaking Cameroon.
“And the breakdown shows that Ogoja has three settlements and is hosting about 22,000 Refugees and in the course of your tour of duty and when you settle down, we’ll appreciate it if you can visit. Your Local Government, Etung, is hosting about 3,000 thousand, Boki, 4,000 thousand, Obanliku, about 4,000 plus, Akamkpa, 4,000, Calabar, about 1,500, Bakassi, about 500 Refugees.
“UNHCR observes that when you see a small community with about 1,000 populations and now you have an explosion, we have what we call, “a shared responsibility on the global compact on refugee,” where the World hopes to support countries and communities that open their hands to accept refugees; so, we provide support for essential services and livelihood opportunities.
“In Cross River State, the UNHCR since 2018, has been improving and providing infrastructures, in the Health sector, which you and I represent, from 2018 we have been the silent pillar of health Care support in the State. If you come to General Hospital, Ogoja, you’ll agree with me that it’s one of the best IRS in terms of outlook and infrastructure. All this was achieved through UNHCR.
“During COVID-19, we extended the pediatric ward of the Hospital and gave them an isolation center with all the equipment to provide the needed services. And through our support in the Insurance Funds; the Hospital was able to use the money to put in place all they needed.
“Across all the Local Government Areas, we’ve been able to touch all the PHC’s. Two days ago, we were in Bakassi, where we renovated the PHC, Ikang, which was destroyed by ENDSARS rioters, where we extended the Health Centre. In Etung, we’ve renovated and extended the Ajasso PHC, as well as the Agbokim PHC.
“In Obanliku, we’ve just completed the renovation of the staff quarters up the Ranch and as last year, we renovated the PHC. Utanga, we renovated the PHC, and this year, we’ve provided them with solar electricity, bringing the total number to 12, across the State, and we promise to provide more. Out of the 12 PHCs, 7, have benefited from solar boreholes. If you go to Bashu, a border community with Cameroon, the PHC was almost on the ground, we took it up and even provided them with solar electricity this year. We had hoped to even provide them with water at the PHC, but a rig cannot cross the bridge to go in and drill for water. So, whenever a bridge has been provided, we’ll move in and get them water, because it’s a flash point where we normally have an influx of Refugees. Recently, the Abazonian separatists have written that they want to attack the community for hosting Refugees and for some other reasons. We are very concerned about those communities and are advocating that the government should do the needful so that we can prevent any breach of peace and the Refugees that are moving into the community.
“It may suffice for you to also know that the UNHCR was able to supply masks that were used in the State, during the COVID and we made sure we partnered with the Ministry of Health. And just last year, we gave the Donate a Complete State of the Art Ambulance and handed it over to the immediate past Governor with every equipment you can think of and the former Commissioner of Health was there. This was to improve Emergency Health Service delivery in the State, and even set up a Committee with the Ministry, to start developing an emergency response protocol with the NCC center, and that is still on track. I want to bring to your attention that, at any point in time, we can rejuvenate emergency response policy development for Cross River State.
“During COVID we worked on the control policy and can produce more copies and thought the Emergency response policy would be very important, so that we’ll have a more robust and quick response on emergencies, on how they manage Hospital services as well. So that both can work symbiotically and your Office can take it up immediately for an effective medical response. And for the Ambulance, if you want more information, we’ll be ready to provide more details you need and documents as well. And during the presentation of the Ambulance, we also provided about 200 geo-styles for vaccination.
“I also want to inform you that we have about 10, oxygen concentrators that have just arrived and will be presented to the State, we have already provided about 20, already to PHCs across the State. So, it will be given to the Ministry to be distributed to various Hospitals.
“This year also, we’ve been able to finish construction of the Okene Primary Health Centre Staff quarters. We started the Health Centre because they’ve none and the Ministry benevolently sends some staffers which we are also supporting. And in Adagon, which almost does not have a Health Centre, we’ve been able to expand the Centre. If you go there, you’ll see for yourself.
“And for 2023, we’ve started constructing Primary Health Centre Staff quarters in Oban and completed the PHC there. We completed that of Ekok-Anaku in Akamkpa last year, and early this year, we completed the staff quarters.
In human resources for health, in most of the locations where we have Refugees, we employ some health workers, ranging from 1 to 5. So, in Cross River State, we’re supporting 92, Health Care workers with the complement of a Nurse-Midwife, Laboratory Technician, Pharmacist Technician, and a Record/Data Assistance in every PHC that we support, which is the minimum compliment, so it helps us in service delivery.
“We’ve tried so many techniques to see what will work better at PHC and the primary challenge is not having a working structure, whoever was in charge buys his drugs, treats, and puts the money in his or her pocket. We had provided medications to the PHCs and saw that, it wouldn’t work, because every time we provide medications, it developed leg and walked away; so, we now imported a method, a Nigerian system but wasn’t well implemented in Cross River State; using the Village Heads Committee (VHC) or Ward Development Committees (WDC) to run drug revolving fund. It’s what we now use with our Partner, the Red Cross, to finance the PHC System. So what we do now is to support all the six elements of the Health Care System; human resources, equipment, infrastructure/innovation, and Data assistants. They attend to the Refugees and we in turn pay them for the service provided, having trained them on quality care, and quality bailing. So, for every Refugee that they see, we still pay the patient so that the system is commercialized. But the challenge we have is that the host nationals don’t have any form of Health Insurance. We’ve optimized the system, they can access free consultations and admission but they need to pay for their medications. Other benefits are the expansion of malaria treatment by MHF and programs. ANC services and HIV services as well.
But we think that, if the State can also set up a rejuvenated pharmacy system, it will go a long way to cushion the entire process and can always buy drugs in advance, even when they don’t have the cash; and can always pay back later after the must-have sold.
“Another key area we wish to be looked into is the employment of staff, for about 96, staff that we are supporting, the least paid after tax deduction on the average is about 70,000 thousand naira, this means that most of our funding is going into paying salaries. So, if the government can employ these staff, we’ve trained them effectively on a lot of procedures, we’ll free more funds to support the government to improve on infrastructures in the context of the global Refugees which is NICR support.
Nigeria is a signatory to the global compact support in Geneva through the support of the UNHCR; as we pledge to continue to support Refugees and communities that host them, to expand resources and amenities to the Communities that host Refugees. So, in this context, I want to encourage your Ministry, that UNHCR willing to support the government of Cross River State which hosts out of the total Refugee population can advocate for the Federal Government through the various Agencies, and thank God, the Minister of Humanitarian Affairs once sat on this seat, and also the National Border Community Development Agency to advocate these Agencies to come to Cross River State, so that they can continue to support these Communities at the Borders, that are hosting Refugees. I see that in Taraba, but have not felt the pulse of the NBCDA in Cross River State, so, UNHCR is willing to support joint advocacy to those Ministries and the National Border Communities Development Agency.
“So, in a nutshell, and summary, we’ve learned some lessons in the about five years of our operations, where we move from free medical services by buying items to performance base financing, job revolving fund, that is working based on support, monitoring, and integration of other Health Services like distribution of malaria nets and antenatal care and support. We’re also doing indoor residual spraying of insecticide to reduce malaria-like South Africa has done by 70% because we saw the rise amongst the Refugees and it was an unacceptable 825 per 1,000 population incidence rate among those under 5. We’ve already done one spray and will be doing another in September,” he said.
At the meeting also were, the Permanent Secretary of the Ministry of Health, Dr. (Mrs.) Pauline Binang Obute. Mr. Mohammed Nafion, Head of Calabar Field Office. Dr. Ernest Afu Ochang, Public Health Lead. Dr. Enoch Asuquo, Project Team Lead, Technical Officer and Clinical Services, NRCS. Evelyn Katono, EH-Assoc. Protection Field Officer. Nurse Mary Takon-BHCO. Comrade Amawu Cletus-Media, NRCS volunteer, and Esther Ibiang-PA to Commissioner of Health,

Amawu Cletus Albert Amawu

I'm a Journalist, Host/Producer of The Verdict, your voice of conscience on FAD FM 93.1, Calabar, Public Affairs Commentator, Social Change Agent.

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