Working towards safer access to health care in Rivers state

Access to health care is not always safe in the Niger Delta region and elsewhere in Nigeria. The rate of attacks on health-care providers, facilities and associated vehicles across the country is high according to data gathered by the ICRC. What's more, these data show a concerning pattern of discrimination against certain categories of wounded and sick people. Below, Dr. Theophilus Odagme, Honorable Commissioner for Health in Rivers state, in the southern part of Nigeria, and a health professional himself, reflects on these challenges and describes how he is working with a group of people committed to bringing about change in the Niger Delta region.

The rate of attacks on health-care facilities is high in the Niger Delta region. As the data collected by the ICRC since early 2015 show, the majority of cases involve the kidnapping of health-care professionals and other types of violence against health-care personnel working in hospitals, primary health centers and clinics. In addition, a number of gunshot victims have been denied care while at a health facility for treatment, and many choose not to seek health care for fear of being arrested. Action needs to be taken by relevant stakeholders in the state, as these tensions between medical professionals, armed groups, security forces and communities mean that health care is being provided on an increasingly discriminatory basis.

In order to address the issue, the Rivers state Ministry of Health expressed willingness to start collaborating on this initiative with the ICRC. The partnership has already achieved a number of encouraging results. A working group was created with the health-care community in the city of Port Harcourt. Participants include medical professionals from both the public and private sectors, the Nigerian Medical Association, nurses and academics, to name but a few. The first meeting was held in May 2016, and the working group now meets regularly. It is a very important platform, as it gives the health-care community an opportunity to come together, share their experiences and discuss the health-care situation in the state. During one of these meetings, for instance, a doctor recounted how his life had been put in danger as he conducted operations under fire, how he and his colleagues had extremely low morale and how his work situation was 'frightening' and 'very traumatic.' Above all, these meetings are a step forward, as the discussion concretely focuses on how the violence against health-care providers, facilities and vehicles can be curbed and access improved. The working group is now developing a protocol and advocacy tool that sets out the rights and responsibilities of health-care professionals when treating patients during emergencies. It has also decided to engage with the Nigerian police force at the federal level in order to develop a written memorandum concerning the Inspector General of Police's directive on the treatment of those with gunshot wounds. Furthermore, it has called on the ICRC to enter into a dialogue with armed groups to address the issue of violence against health care in Rivers state.

The working group is also engaged in a number of activities aimed at distributing important information to the public, security forces and armed groups and raising awareness of the obligation to safeguard health-care services. It has, for example, created a poster that explains: the laws regulating and safeguarding access to health care, particularly in relation to each patient's right to non-discrimination; those protecting medical ethics and confidentiality, the wounded and the sick, medical personnel, medical units and transport; and those regulating the use of the red-cross emblem, the distinctive emblem used by health-care professionals in Rivers state. The poster will be displayed in hospitals and clinics across the state.

The working group is also developing a data collection tool in consultation with the Ministry of Health. The aim is to create a mechanism that ensures regular, pertinent and accurate data collection on incidents affecting the delivery of health care in the state. The tool should be used to better analyse trends and threats involving health-care personnel and patients.

We are convinced that our efforts mark the beginning of a positive change in our region, and we hope that the work we are doing to improve health-care delivery will serve as an example and inspiration to other states in Nigeria and around the world.

Dr. Theophilus Odagme, FWACS; MNIM

Hon. Commissioner for Health