UGWUAJI, ENUGU: On May 16 this year, at the premises of Community Primary School in Ugwuaji community, Enugu South Local Government Area in Enugu State, the elderly, both men and women, 60 years old and above numbering over 50, sit patiently on plastic chairs, donning their face masks.
They had come from different locations across the community to receive free medical care. One by one, they walk towards a direction where medical professionals sitting separately under the coverage of canopies attend to the elderly. The healthcare providers have various kinds of medical equipment and drugs for treating varying degrees of illnesses.
The care providers, about 30, are part of Gburucare, a free mobile clinic. The clinic was launched early this year by the state governor, Ifeanyi Ugwuanyi, to tackle the challenges faced by the elderly in accessing healthcare across the 17 local government areas of the state.
Soon, it gets to the turn of 67-year-old Monica Ene. She walks in the direction of a physiotherapist to have her body checked. She had been having back pain throughout the past year. But with no money to treat herself, she hardly stepped out of her house.
"When I got to the physiotherapist, I told him I was having back pain. He asked me the kind of activities I usually got involved in, and I told him I was into sand dredging but had stopped,” she explained.
The physiotherapist ran a check on her and said the sand dredging had affected her backside. After the test, she was directed to a doctor who wrote down a list of drugs and directed her to a pharmacist who gave her the drugs for free to cover a one-week treatment schedule.
The drugs helped reduce Ene’s back pains, enabling her to do some of the things she could not do effectively prior to the treatment, including walking and bending.
“I would have been indoors with nowhere to go if not for the intervention of the Gburuscare,” She said. “I am glad I benefited from the initiative.”
Ene is just one out of about 5000 older people across different communities in Enugu State benefitting from GburusCare.
Derived from Gburugburu, the governor’s nickname that translates to [king] “over all” in English, the initiative is the governor's personal healthcare project. It aims to provide free regular medical care to 25,500 older people in 170 remote communities in the state by mid-2023, according to Darlington Ugwuegbe, the governor's technical assistant on healthcare and coordinator of Gburucare.
Ugwuegbe said about 5,000 elderly persons in 15 communities have benefitted, since the launch.
A complex mix
As people grow older, their health declines and their health needs become complex. They also develop an increased likelihood to pick one or more diseases, including hearing loss, back and neck pain, diabetes, depression, dementia, hypertension, high blood sugar, ulcers, and arthritis.
By 2050, the number of people older than 60 years globally would almost double from 12% to 22%, totalling 2.1 billion. About 80% of them would be found in low and middle-income countries like Nigeria.
Nigeria has the largest elderly population in Africa - 10.9 million. That number is expected to swell to about 33.2 million by 2050, making the country the eleventh largest older population in the world. To meet the different needs of this group, including access to effective healthcare services, a clear national plan is required.
But, sadly, Nigeria presently has no functional national policy that caters to the welfare of the elderly. And effective out-of-pocket care is a luxury for some older people, most of whom live in extreme poverty. It explains why initiatives like Gburucare is a relief for some beneficiaries.
How it works
A combined team of 30 health professionals delivering the service includes physiotherapists, pharmacists, nurses, medical doctors and medical laboratory scientists.
While the nurses record patients' symptoms and medical history, the medical laboratory scientists conduct tests for blood sugar, hepatitis B and C, malaria parasites, and other possible ailments using a rapid diagnostic test or RDT.
The doctors counsel and prescribe medications that would then be dispensed to the patients by a pharmacist. The physiotherapists address the illnesses or injuries that limit the abilities of the elderly to move and perform some activities in their daily lives.
The team visits at least two communities every week, one day per community. Before it visits a community, they inform the town union president, the traditional ruler of the community and other critical stakeholders who would, in turn, spread word about the visit to members of the community who fall into the target category.
During each visit, the team is divided into two; one attends to patients who come to the designated area in the community, and the other proceeds to deliver door-to-door services.
“While the stationary team positions at a spot in the community to receive patients, the mobile team proceeds to the homes of patients who are unable to come to the spot,” said Ikechukwu Obi, State commissioner for health.
The programme also creates a folder for each patient attended to. The folder, containing a patient’s medical history, is sent to a community health centre nearest to the patient. The patient is then encouraged to visit the health centre regularly for examination when they feel sick. They are discouraged from self-medication.
Referring them to healthcare centres is important because "Most of these people don’t even visit the hospital or health centre. They don’t even know some of the ailments they are down with," said Ugwuegbe, Gburucare’s coordinator.
"Maybe the person is having a swollen leg, and she is thinking that she had marched a charm or something. So, we do diagnosis and confirm some of these things, then send their folders to the health centre.”
To ensure that the services delivered by the Gburucare team are of an acceptable standard, the initiative partners with the Enugu State Primary HealthCare Development Agency, which is responsible for community healthcare supervision, for quality assessment.
George Ugwu, Executive Secretary of the agency, said the agency is satisfied with the way Gburucare mobile clinic, enhanced by the agency’s supervision, has encouraged hundreds of older people to visit health centres and shun self-medication.
“If you establish health centres, people might, out of fear of how much it will cost, refuse to come around,” Ugwu said. "But If you take healthcare to them, they will see how much they need it. And that is exactly what the initiative is all about”.
However, since it is a personal initiative of the governor who would be leaving office in June 2023 after his second term expires, how well and how long the project would be sustained remains a concern for some beneficiaries who fear that it might end when the governor leaves office or even sooner.
They also complained that the Gburucare initiative merely sends their folders to local health centres without covering or subsidizing their medical bills at the health centres. Some said they had initially believed that the Gburucare would cover at least part of their medical expenses at the health centres.
What it means is that some of them who picked the advice to visit health centres for their health needs might return to self-medication, which they consider a quick and cheap option since many of them cannot afford to pay their complete medical bills each time they visit the healthcare centres for help.
Sadly, Ene is among those who have already returned to self-help. “After they came on May 16, we did not hear from them again [regarding subsidizing or paying our bills at the health centres],” she said. “(Now) each time I feel pain in my back, I just go and get drugs [for] myself.”
But Ugwuegbe said the initiative is currently in discussions with the governor and potential partners to raise funds to cover the full medical bills of patients whose folders have been sent to community health centres, completely discourage self-medication and sustain the project beyond 2023.