Increasing use of reproductive health services through community-based and health care financing programmes: Impact and sustainability in Abia State of Nigeria

Enwereji Ezinne E¹* and Enwereji Kelechi O²

¹College of medicine, Abia State University, Uturu, Abia State, Nigeria

²College of Medicine, Nnamdi Azikiwe University, Awka, Anambra State

*Corresponding Author’s E-mail: hersng@yahoo.com

Accepted 03 May, 2013

Abstract

Studies have shown that the governments’ central role to guarantee access to reproductive health care is to provide and finance services at all levels.  In Nigeria, budget constraints limit this role.  The question is, how do individuals in rural areas access sexual and reproductive health (SRH) care services?  Study explored health care financing mechanisms and burdens the mechanisms impose on reproductive health needs within the context of free and informed choices. In-dept interview which was recorded and transcribed was conducted with 24 key informants within the ages of 25-58years. The informants are made up of 8 women and   men respectively, who are community leaders in the study area.  Also interviewed are   8 nurses in charge of primary health centers in the study area. Data collection and analysis were qualitative.  Measures of social connections through coordinated analyses of ethnographic data and    enabling conditions for scale-up were emphasized. Findings showed that the  government   provided little or no    reproductive health  care services in rural areas. The study identified  myriad   ways in which community members financed   SRH services. These  include “isusu”(weekly out-of-pocket contributions), palm fruit harvesting levies, community-based monthly  levies and individual  donations.  The amounts   generated from these methods are   paid into community common purse. From this common purse, sexual and reproductive health (SRH) services are paid for. The study noted that individuals who did not contribute towards this fund are usually denied the benefits of these services.  In the words of three respondents,” we ensure that we pay for our health care bills   through community efforts. We do not want our wives and children to continue to die while waiting for free services from government which will never come”. Two respondents specifically maintained that   we have lost a good number of our children   through this neglect. We shall continue to assist ourselves”  Given the numerous health, social and economic problems inherent   in the  rural areas in  Nigeria, a  mixture of public and private financing of health care services  is   preferable. This will ensure more accessibility of reproductive health care services, and thereby, help to reduce maternal and child mortality in the rural areas. This study constitutes valuable tool for those interested in identifying how maternal and child mortality rates could be minimized in the rural areas.

Keywords: mortality, health financing, reproductive health, accessibility