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Enugu Forum Policy Seminar on Community Directed Intervention in Health Care Provision


May 5, 2010- Stakeholders who converged at the Development Policy Seminar (Enugu Forum) organised by African Institute for Applied Economics (AIAE) strongly canvassed for the strengthening of Community Directed Intervention (CDI) in provision of health care facilities and services in different communities in African countries.

The theme of the Seminar held at Bridge Waters Luxury Suites, Enugu attracted several practitioners in health sector, community leaders, academics, government functionaries, technocrats, researchers, Organised Private Sector (OPS), was “Community Directed Intervention and Healthcare Provision in Africa”.  The Forum was chaired by Dr. B.S.C. Uzochukwu, a Fellow of the West African College of Physicians and Consultants and Public Health Physician of the University of Nigeria Teaching Hospital, Enugu and also doubles as a Senior Lecturer in the Department of Community Medicine and Health Administration and Management the same Teaching Hospital.

In his welcome remarks, the Executive Director of the Institute, Prof. Eric Eboh opined that Enugu Forum is a civic platform for informed and evidence-based debate about public policy options and development issues. He added that the Seminar is composed of an alliance of like-minded NGOs, PSOs and professional groups, an interactive forum for public policy dialogue among stakeholders and an opportunity for interaction between researchers, policymakers and development practitioners among others. The ED said the theme was chosen to underline AIAE’s commitment to influencing important government’s policy through evidence-based policy debate, “and the place of health policies as they affect the community is of great importance to us.” Since the outputs of the Forum have, since inception, been generating public interests, he therefore called for the buys-in of all.     


The Guest SpeakerProfessor Joseph Chukwudi Okeibunor, Head, Department of Sociology, University of Nigeria, Nsukka, who spoke on Community Directed Interventions and Health Provisioning in Africa: Low Cost Strategy for Attaining the Millennium Development Goals on Health,stressed that CDI approach makes the community to take charge of the process, usually through a series of community meetings for decision-making on implementation and how to carry out its roles in the implementation. He said, “Commitment to community empowerment process is of primary importance in CDI and it is critical that all partners demonstrate commitment to this process. Partners, especially health system should not dominate but rather contribute according to their roles and responsibilities to empower the communities, and that they share a common objective. Buttressing his points, the University don noted, among others, that “success of CDI is linked to the relative simplicity of the implementation of the interventions.  Distribution of nets and distribution of vitamin A require very simple techniques. The requirements of technical expertise are minimal in each case.  Community members are easily trained to deliver the commodities and diagnosis is simple.  With the community members in charge of distribution, it becomes easy to promote community ownership and sustainability.  When the communities are adequately engaged in the programme, they work assiduously to promote its success”.

 In his commentaries, a discussant at the Seminar, Dr. Ikechukwu E. Obi of the University of Nigeria Teaching Hospital (UNTH), stated that Community Directed approach to health care essentially entails an empowered community taking charge of the delivery of a health intervention.  He added that this would work better ideally from planning, implementation to evaluation stages, facilitated by the formal health system and other stakeholders working in partnership. 

Rev Father Hyacinth Ichoku  of Economics Department University of Nigeria Nsukka  (UNN) also discussant noted that  CDI represents another of many efforts aimed at overcoming the political and bureaucratic hurdles that severely constrain the application of resources to address social needs of needy populations. “The critical assumption is that unequal social power structure and the distribution of social services built on prebendalism that leaves large numbers of the Nigerian population short-changed. Large segments of rural populations, the poor, ghetto dwellers, women and children stand disadvantaged in the political economy of Nigeria. The CDI seems to me to represent an attempt to use the community as a vehicle to empower the powerless, to reach the hard-to-reach, and give voice to the voiceless in the distribution of social services.”

According to him, CDI is claimed to represent a promising improvement over existing method of distributing health resources, adding that it is also claimed to lower operational costs. “However, are these attributes likely to be retained when diffusion of organizational change occur? The process of transforming community-based primary health care system as represented by CDI involves large-scale organizational change,” he averred.

Others who contributed greatly to the discussions included Mr Frank Amagwu, Chairman of Steering Committee, Enugu Forum, representatives of Enugu and Imo States Commissioners of health, Professor Gini Mbanefoh, former Vice Chancellor of UNN, representatives of DFID, UNDP, YDF, NDE, PATHS, UNICEF, civil societies and the media. They all submitted that CDI is proposed as a more sustainable health intervention process which lies in the involvement of the community leaders and the relevant stakeholders in the entire process. Other recommendations include the use of CDI as a complimentary tool. It should be used in conjunction with more enlightenment both for health workers and community members. In addition, the political economy of organisational change was also proposed. This will put the CDI process as a broad-based tool for community health intervention when scaled up to capture other community health intervention scenarios.

The Seminar was attended by 180 participants.

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