UNICEF health workers and hard-to-reach communities: An experience, By Tina George

Nigerians have consistently complained over the decaying state of health facilities and services across the country but most times ignore the health workers and how they cope in the face of so many work loads.
In 2017, Nigeria was ranked 7th among 57 countries classified as facing a critical shortage of health workers as current statistics show that in Nigeria, the health workforce density is estimated at 1.95 per 1000 population.
Recently, the Reporter embarked on a media tour to some hard to reach communities in Niger state where UNICEF carries out its Hard-to-Reach medical outreach program; while a lot have been said of the communities which have been living without basic amenities for years, The Reporter focuses on the health workers who take their time daily to visit these settlements.
Most of these health workers go to communities that are as far as 12 kilometers from the main town, riding for 30 minutes to an hour on motorcycles; riding on rocky hills while some crosses rivers and streams to offer their services to the people.
Mrs. Rekiya Usman, a nurse and Midwife who is the team leader of the UNICEF Hard-to-Reach medical team in Shiroro local government area who spoke to the Reporter in Moilo community in Wushishi local government said daily, she spends six hours in the communities where they offer their services explaining that the roads have been their major challenge as all the roads leading to the communities they go are not passable in any way.
UNICEF team crossing a stream to their destination
“Daily, we get to the local government area latest by 8 am and we then proceed to the community we are suppose to go, sometimes, we ride on motorcycles for about 30 minutes, other communities takes us up to an hour. We visit different communities daily to ensure that our services are felt.
“We spend roughly six hours daily in these communities, at times, when we arrive, they are not usually available, we wait for them to return from where they went to and we attend to them according to their medical needs.”
Speaking on the journey to the hard-to-reach communities, Rekiya said, “The journey na elele, the roads are really hard to reach, while some places are fair, others are not but no place takes us less than 30 minutes to get to on motorcycle.”
The Nurse/Midwife who said their services is the only medical service the people in the hard to reach communities have access to as the closest health center is about 10 kilometers from the community saying that once the UNICEF Outreach program which is slated to end in December rounds up, the people would no longer have access to quality health services until they travel the distance to get it.
“If given the opportunity, I would like UNICEF and the state government to continue the hard to reach medical outreach and even if the programme eventually ends, I pray the state and local government will pick up the programme and sustain it so that the communities will not be left behind health wise. Whenever we try to sensitize them that our services to them would soon come to an end, they feel sad and express their unhappiness and unwillingness for us leaving them. Government has to take over from where we stop.”
UNICEF team attending to patients
In Lugokpma community in Wushishi local government area, Mrs. Hausatu Jiya who is the Nurse/Midwife said she mostly set out daily with palpitations in her heart especially gauging on how high the water level would be, “There are some areas when we go there, we have some palpitations, some fears as to what the river would be like and how we are going to cross it.  Earlier this year, when the rains were heavy, I almost drowned while crossing the river, it took the help of the motorcycle rider who held my hand that prevented me from drowning.
“At times, before we get to the communities, the people are already waiting and they will be sensitized by the community mobilization worker; many at times, we have to wait for them until they return from the farms, then we attend to them. However, there are some cases we cannot treat and when we refer them, they are reluctant to go because of the distance, we would have loved to help these people but we do not have the means to do that.”
Jiya said that the team need to have a heavy duty vehicle that would be able to ply the road to enable them take some patients to the hospital, ”most times, I feel I am not doing my best, I will really want the community to have a clinic where they can get access to health services and also a bridge to be built for easy road access so that they would be able to take themselves to the hospital.”
In Niger state, there are there are over 4000 Hard-to-Reach communities which are usually 5 kilometers or more from a functional primary healthcare center, they are usually without any basic amenities including portable water, electricity, schools, health facilities, good road network and even mobile network but the UNICEF medical outreach is only spread across 850 of such communities.
The communities in the hard to reach program in Niger state has appealed to UNICEF to continue its ‘Hard-to-Reach’ medical outreach services and not to leave it in the hands of the state government as government has no means to sustain the project.
It was learnt that the Hard-to-Reach medical outreach programme began in Niger state in March 2016 and is slated to end by December 2018.
A visit to three of the Hard-to-Reach communities in Shiroro, Wushishi and Kagara local government areas of Niger state revealed that the demands of the people were the same, they did not want the programme to end as an end to the programme would signal a decline to their health status.
In Moilo community in Shiroro Local Government Area, one of the Community Leader, Alhaji Bulus Zarumai who described the UNICEF Hard-to-Reach programme as God-sent to the people in the community said the presence of the health workers had saved a lot of lives of children in the community especially children under the age of five years adding that since the inception of the programme in 2016, there have been no incident of maternal mortality in the community and malnutrition cases have been reduced to the minimum.
“UNICEF is God’s sent, they came to heal people from different diseases especially in my community. The presence of this organization in my area has saved a lot of lives that could have been perished; it affords our children the opportunity to be immunized against killer diseases that are killing children under the age of five. “
Zarumai lamented over the lack of government presence in the community which is telling on their children and women as the children cannot conveniently go to schools especially as they will have to trek orb take motorcycles to the nearest town which will take not less than 30 minutes on motorcycles and an hour walking on foot.
 In Lugokpma community in Wushishi local government, the people would have to cross two streams, the Community Head, Adamu Mohammed, what the community need most is a bridge across the streams which during rainy season is not cross-able and a health center, “if possible, they can retain these health workers and build a small clinic for them to stay, and we are ready to provide them with accommodation. We enjoy their services especially as they give us free drugs, something we have to pay for in government hospitals.”
He urged the UNICEF not to leave the programme in the hands of the state or local government as it will fail, “if government takes over, they will only squander the funds, they will not continue with the work these people are doing. Please UNICEF, government cannot sustain this programme, please continue with it and do not leave it for them.”
The UNICEF Cluster Coordinator in Niger state, Umaru Musa said that the condition of health centers before the intervention of UNICEF was nothing to write home about urging the government to improve the health facilities in the state, “UNICEF Hard-to-Reach programme in Niger state has tremendously saved a lot of lives that could have been lost. We have saved lives; death rates have been reduced to the lowest point.”
He said that the major challenges faced by the health field workers was lack of accessible road to the remote communities in the state while during the raining season, there are dangers of the health workers drowning and crossing the rivers which is done by swimming.
Reacting to the cry for sustainability, the Niger state UNICEF Coordinator, Dr. Muhammad Khalid said that donor partners are catalysts for development as they have not come to take over government functions, rather, they try to catalyze government to do the needful for the population by sharing their vast experience and showing government that a certain concept have been tried and is workable for them to implement it.
He said that he hoped government would look at their models and be able to sustain the project for the hard to reach communities in order for the state not to suffer a relapse in its health indices just as he pointed out that 70 to 90 per cent of the people in the hard-to-reach communities depend on basic primary healthcare for their day to day health activities.