Championing Transformative Healthcare in Ekiti through Holistic Health Systems 

In striving to be a regional health hub, and even beyond, Chiemelie Ezeobi writes that from infrastructural development to service delivery, health financing, public health security, community engagement and social mobilisation, health information system, health workforce and capacity development, leadership and governance, and research, Ekiti State  government has invested considerably in delivering a transformative healthcare system that is robust, resilient, and inclusive

The inalienable right of every Nigerian to equitable access to quality healthcare cannot be overstated. A firm believer in this right, the Ekiti State government has continuously underscored its commitment to not just delivering a healthcare system that works, but also one that is robust, resilient, and inclusive. 

For Governor Biodun Oyebanji, keying into the right initiatives that leverage digital solutions for the improvement of the health sector was key. To achieve this, he walked the talk with the appointment of the Dr. Oyebanji Filani to head the Ministry of Health and Human Services as Commissioner. 

With his knowledge on health financing and policy reform, Filani, who also doubles as the chairperson of Nigeria health commissioners forum, has been able to bring the right mix of technology and policy reforms in tailoring and driving the health systems of the state, a feat he acknowledged was based on the level of support the ministry has gotten from the governor. 

Suffice to say that in Ekiti, the government has demonstrated significant commitment to improving the health status of the populace through a holistic approach to health systems development with particular emphasis on strengthening primary health care system as a way of promoting universal health coverage. 

Governor Oyebanji’s administration has also invested considerably in the health sector, which has upped the health indices of the state, as shown by the data mined from January to August 2024 on infrastructural development, service delivery, health financing, public health security, community engagement and social mobilisation, health information system, health workforce and capacity development, leadership and governance, and research. 

Infrastructural Development

In terms of Infrastructural development, the state government has installed a new mammogram machine at the Ekiti State University Teaching Hospital to increase access to early detection of breast cancer; upgraded the Ikole Specialist Hospital to a Federal Medical Centre; as well as the the upgrade of the Ekiti State Drug and Health Supplies Management Agency warehouse to a pharma-grade facility.

According to the commissioner, this milestone was achieved through a signed Memorandum of Understanding between the Federal Ministry of Health and Social Welfare and the Government of Ekiti State as the upgrade not only elevates the hospital’s status but also secures increased federal support and resources, thereby enhancing the quality of care and expanding the range of services available to patients.

Also, The Global Fund provided a Toyota Hilux program utility vehicle for Tuberculosis and HIV Control Program, ensuring that TB and HIV control efforts are efficient and effective, while IMPACT procured an Hilux and a bus for utility purposes, enhancing the capacity for program monitoring.

The state government also constructed a 1.85km HMB/Doctor’s Quarters road, including a bypass to reduce burden of health workers going to give care at the hospital. However, beyond this, at the moment, renovation of nine outstanding general hospitals and equipment are ongoing in Ijan Ekiti, Ijesa Isu, Ilawe, Okemesi, Efon Alaaye, Iye Ekiti, Ayede Ekiti, Ilupeju / Itapa Ekiti, and Ifaki Ekiti general hospitals, as well as the Government House Clinic in Ado Ekiti and Hospitals Management Board, also in Ado Ekiti. 

Health Financing

As a core function of health systems, health financing pushes for progress towards universal health coverage by improving effective service coverage and financial protection. In Ekiti, this ethos is also key for its Ministry of Health and Human Resources. 

Presently, they have enrolled all 3.6 million residents of Ekiti into the Ulerawa Health Insurance Program, with almost 400,000 citizens utilising free, high-quality healthcare services this year alone while 19,000 pensioners were also enrolled into the Ekiti State Health Insurance Scheme for increased access to essential healthcare services.

Not done, the state registered over 1,000 persons for surgery, with 548 free surgeries performed, including herniorrhaphy, caesarean sections, cataract surgeries, 

myomectomies and lump excisions—transforming the lives of many residents. It also disbursed ₦100 million to 105 individuals for medical support, enabling access to critical treatments, surgeries, and medications.

Expatiating, Filani said as of September 2024, Ulerawa, the Ekiti State Government’s flagship health insurance program has enrolled 3.6 million residents and 403,371 citizens have utilised free, high-quality healthcare services. “Ulerawas  has  paid over two hundred and seventy-three million naira to PHCs in reimbursement for residents who has utilised free, high-quality healthcare services in ANC, Under-5 Malaria, Bacterial Intestinal Infection, Diarrhoea, Measles, Micronutrient Deficiency, Upper Respiratory Tract Infection, Family Planning, Immunisation Tranche 1, Immunisation Tranche 2, Adult Malaria, Delivery, Referral ANC, Xerophthalmia, Referral for Under-5s.”

In terms of the Basic Healthcare Provisional Fund (BHCPF), he noted that it offers a basic minimum health package that covers maternal and child health, care for vulnerable groups—including people living with disabilities, sickle cell warriors, the elderly, pregnant women, and children under five years—and general treatments such as malaria .

As of August 2024, the fund had enabled 179,059 residents to access vital health services, with ₦421,774,350 disbursed to 175 accredited Primary Health Care facilities across the state as capitation payments. In addition, 1,950 enrollees benefited from advanced treatments after being referred from PHCs to secondary healthcare facilities, with an additional ₦63,525,897.26 paid for these services.

 Attention to Service Delivery

As a core function of health systems, Service Delivery takes shape in Ekiti by providing patients with the treatments and supplies they need at the moment.

For 210,619 girls between the ages of 9-14, they were vaccinated with Human Papilloma Virus (HPV) vaccine, achieving 91 per cent coverage, as well as an increased number of individuals on HIV treatment to 93 per cent of the estimated cases of People Living with HIV/AIDS (PLWHA). 

Infact, the Ministry has made significant efforts in enhancing HIV service delivery as part of a broader strategy to reduce mother-to-child transmission (MTCT) of HIV and to scale up prevention, testing, and treatment services across the state. As of December 2022, 8,536 individuals were on HIV treatment, which increased to 11,465 by June 2024, according to the National Data Repository (NDR). 

Additionally, the 95-95-95 cascade of care has shown notable improvement: in the first 95, related to case finding, Ekiti is at 93 per cent; in the second 95, concerning linkage to care, Ekiti is at 95 per cent; and in the third 95, pertaining to viral suppression, Ekiti stands at 97 per cent. 

Not done, they also distributed 71,430 Long-Lasting Insecticide Nets (LLINs) to improve the prevention of malaria, as well as provided 600,603 vitamin A supplements, with 81 per cent coverage for children (6-59 months) while screening 1,600 civil servants, focusing on hypertension, obesity, and diabetes, with timely referrals.

Also in the kitty were 1,307 women, who were screened for cervical cancer, which led them to identify 19 positive cases, with 15 receiving treatment. Additionally, to drive demand generation for maternal and child health services, the ministry recruited over 350 volunteer workers under the Ekiti State Health Vanguards (EKSHV) in all 16 LGAs. 

More importantly, the MOH&HS has improved emergency medical care by successfully integrating its ambulance services into the National Emergency Medical Systems and Ambulance Services. This integration has markedly enhanced response times and coordination, ensuring that emergency medical care is delivered more efficiently across the state. 

For Tuberculosis control, the state made significant progress through strategic integration of TB services with various public health programs and the optimisation of diagnostic capabilities across all healthcare tiers, leading to improved TB case detection and management. 

Another significant stride made by the state is in combating malaria through a multifaceted approach designed to enhance prevention, diagnosis, and treatment. According to the commissioner, central to these efforts has been the comprehensive distribution and monitoring of LLINs across all LGAs.

In the state, the implementation of Maternal, Newborn, and Child Health Week (MNCHW) twice a year has been a cornerstone of the state’s efforts to improve maternal and child health as the ministry provided 600,603 vitamin A supplementation in addition to malnutrition screening, deworming tablets, reaching 81 per cent of children aged 6 to 59 months. 

Public Health Security

With public health security, which is a framework for protecting populations from external health threats, such as pandemics by improving the ability to detect, prevent, and respond to infectious diseases through public health surveillance and partnerships between states, the Ekiti State government has been in form.

To do this, in 16 LGAs, they distributed essential medical items to primary and secondary health facilities while carrying out the quarterly infection prevention control (IPC) supportive supervision, across health facilities, as well as successful cholera sensitisation campaign, which led to zero reported cases.

The Ekiti State Ministry of Health and Human Services has strengthened disease surveillance, public health education, and healthcare delivery across the state. Through routine data collection and analysis, the Ministry closely monitors epidemic-prone diseases and supports real-time tracking on SORMAS and SITAWARE. 

Monthly supervision ensures the effectiveness of malaria programs, while the Rapid Response Team actively monitors all 16 LGAs for emerging health threats, including malaria and diphtheria, and engages in community sensitization. 

 The ministry has also promoted health screenings and community outreach, such as a cervical cancer screening initiative that reached over 1,300 individuals in early 2024 and raised awareness through rallies and advocacy visits. 

Additionally, a health screening for civil servants covered 1,600 individuals, assessing them for hypertension, obesity, and diabetes. Essential health supplies are consistently distributed to primary and secondary facilities across the state, with ongoing Infection Prevention and Control (IPC) supervision and yellow fever vaccinations to reinforce public health measures. Intensive case searches for Vaccine-Preventable Diseases have been conducted, with emergency response coordination maintained through the Public Health Emergency Operating Centre’s call center.

Community Engagement and Social Mobilisation

In terms of community engagement and social mobilisation, the state has issued public health advisories on Diphtheria, Cholera, and Mpox, which were widely disseminated, raising awareness and strengthening prevention efforts across the state, as well as conducting extensive cholera sensitisation campaign in all LGAs, resulting in zero cases being reported.

Paying attention to social mobilisation, they have also boosted acceptance of vaccines by carrying out a robust and inclusive social mobilisation strategy with state health educators leading advocacy visits to key ministries, such as Women Affairs, Education, Local Government, and the Teaching Service Commission, fostering sector-wide collaboration. 

For a holistic approach, religious leaders were involved while extensive outreach campaigns were conducted, and radio jingles were aired at peak times to maximise public engagement.  

For the HPV Vaccination campaign, the ministry also organised town hall meetings to address concerns raised by vaccine-hesitant schools and churches. In addition, letters were distributed to schools to keep stakeholders informed. These efforts led to the successful administration of the HPV vaccine to 210,619 girls aged 9-14, achieving a coverage rate of 91 per cent and making substantial progress in preventing cervical cancer.

One of the highpoints was the introduction of Ekiti State Ekiti State Health Vanguards (EKSHV), who are trained officers from to drive improvements in maternal and child health in their respective communities. 

For Global Health Days, the state commemorated several global health observance days through public events and awareness campaigns, reinforcing key health messages and promoting healthier lifestyles like the International Day of Zero Tolerance for Female Genital Mutilation (FGM) on February 8th, in collaboration with the Ministry of Women Affairs, strengthening the fight against FGM in the state.

Other days like the World Hypertension Day was marked on May 17th, 2024, through a road walk and public campaigns; 2024 World Health Day through a road walk  on “My Health, My Right,” emphasizing the importance of individual health rights; World Malaria Day; World Tuberculosis (TB) Day; and Breastfeeding Week  highlighting the significant health benefits of breastfeeding, helping to promote maternal and infant health across the state.

Health Information System

To build digital systems of open data that are used to generate strategic information for the benefit of public health, the government provided tablets to 177 primary health facilities to improve patient data management and streamline health insurance claims and at the same time, compile a comprehensive database to integrate traditional medicine into the broader healthcare framework.

This is important because in an era where data drives decision-making and the efficient delivery of health services, Ekiti State has made substantial progress in developing a robust Health Information System (HIS).

For the state, a key aspect of the data management was the tracking of Health Expenditure data across the entire health sector. This they have done by closely monitoring and analysing information, thus ensuring accountability and better resource allocation for health initiatives throughout the year.

Also, the ministry conducts Monthly LGA Data Validation Meetings, which have been institutionalised across all LGAs since January 2024, to review data reporting tools from each facility. According to the commissioner, regular engagement addresses data discrepancies and ensures harmonisation of health data, further strengthening the state’s health information system.

In recognition of the importance of traditional, complementary, and alternative medicine, the ministry compiled a comprehensive Traditional Medicine Database, an effort to critically integrate traditional medicine into the broader health system, ensuring that practitioners are recognised,, regulated, and monitored, thus allowing for a more inclusive healthcare framework.

The ministry also updated the Health Partners Database, ensuring accurate and up-to-date information on partners contributing to the state’s health initiatives. In addition, Human Resources for Health Data from various regulatory bodies were collected and updated, ensuring the availability of accurate workforce data for planning and capacity-building efforts.

Health Workforce and Capacity Development

Even with technology, the import of a workforce with the right capacity cannot be overstated. A firm believer in this, the government trained 200 health workers and 20 medical professionals on Gender-Based Violence (GBV) and Female Genital Mutilation (FGM). For the GBV and FGM trainings, they were done to build their capacity as frontline service providers and community leaders 

while 34 mid-level and senior health managers completed a rigorous Healthcare Management and Leadership training program organised in collaboration with the Center for Epidemiology and Health Development and Vrije Universiteit Amsterdam.

Also, senior-level staff from the State Ministry of Health attended an executive course at Lagos Business School Executive Education; 48 state officers and 80 LGA officers across 16 LGAs participated in State Level Leadership and Management training; and 350 facility-level staff were trained in quality improvement modalities to enhance health service delivery across the state.

For monitoring, evaluation and surveillance trainings, they participated in the NMDR and surveillance training by NMEP in Lagos. Furthermore, state officers organized cascaded training on integrated Polio and VPDs surveillance for LGA teams in August 2024, followed by an annual training for community informants. Training on malaria surveillance, including a refresher for DHIS2 use, was also conducted for logistics and M&E officers in Akure, Ondo State.

Others include Health Logistics and Laboratory Capacity Trainings for molecular lab scientists on PCR diagnosis for LASSA fever, while laboratory scientists at secondary health facilities received training on microscopy and logistics management while training on logistics management was also provided for LGA Logistics Officers.

Several capacity-building programs on data management were organised on HMIS digitisation and NHMIS-LMIS Data Triangulation in Lagos and Ado-Ekiti, as well as trainings for malarial M&E officers on DHIS2. 

Leadership and Governance

The Ekiti State Ministry of Health and Human Services has demonstrated strong governance and leadership in its approach to public health, focusing on proactive monitoring, community outreach, and resource management. Through strategic oversight, the Ministry has created an effective system for tracking epidemic-prone diseases, enabling swift responses to emerging health threats across the state. This governance model prioritises data-driven decision-making, with Integrated Disease Surveillance and Response (IDSR) data collection as a foundational tool. 

It’s leadership in managing malaria programs showcases its commitment to public health at both local and state levels as the monthly supervisory visits ensure that malaria initiatives are implemented effectively, while any issues identified are promptly addressed to maintain program quality. The Ministry’s Rapid Response Team (RRT) further supports this work by actively searching for cases of malaria and other epidemic-prone diseases in all LGAs. 

Community engagement has also been a core part of the Ministry’s leadership strategy. Recognising the importance of public awareness in disease prevention, the ministry has led several sensitisation campaigns targeting specific health issues, such as diphtheria. Through public education and outreach, it has effectively communicated preventive measures and treatment options to communities, while improving safety standards for medicine distribution, ensuring community health and safety are prioritised through license renewals for Private Patent Medicine Vendors (PPMVs).

Preventive health screenings illustrate the ministry’s proactive governance approach in protecting public health. Early in 2024, a cervical cancer screening campaign reached over 1,300 individuals across all LGAs, including hard-to-reach communities. 

In a further demonstration of its commitment to good governance, the ministry has ensured a consistent supply of essential health commodities to both primary and secondary facilities across the state. Through efficient resource distribution, the ministry has maintained the continuity of medical services, strengthening healthcare infrastructure in a way that enhances community resilience against health crises. 

The ministry’s infection prevention efforts also underscore its leadership in facility readiness and safety. Quarterly Infection Prevention and Control (IPC) supervision for healthcare worker management is conducted, providing facilities with ongoing support to enhance preparedness for health threats.

Another pillar of the ministry’s governance is its efficient use of digital platforms for real-time disease surveillance. By integrating the SORMAS and SITAWARE systems, the Ministry has enhanced its capacity to monitor and respond to health threats as they arise, demonstrating a commitment to modernising public health infrastructure. This use of technology exemplifies the Ministry’s forward-thinking approach, ensuring that Ekiti State remains agile and prepared in the face of potential outbreaks.

Research

In 2024, the Ekiti State Ministry of Health and Human Services conducted three pivotal studies to gain insights into healthcare utilisation and accessibility across the state. These studies—focusing on facility-based deliveries, willingness to pay for health insurance, and community health network mapping—were part of a data-driven approach to better understand the healthcare landscape and identify barriers to effective healthcare delivery and insurance enrollment.

To address the decline in facility-based deliveries, the Ministry commissioned NOIPolls to investigate why fewer births were taking place in health facilities. This study highlighted key factors such as the attitudes of health workers and the influence of spouses on women’s choices regarding delivery locations. The findings provided the Ministry with evidence-based insights to develop targeted interventions aimed at increasing skilled birth attendance, addressing these identified barriers to improve maternal health outcomes across Ekiti State.

In assessing the willingness to pay for state-sponsored health insurance, the Ministry aimed to ensure the sustainability of ULERAWA, Ekiti State’s health insurance scheme. With support from GIZ-Backup Health, the Ministry partnered with the Devstork Platform for Development (DPD) to conduct a study on the willingness and ability to pay (WATP) for health insurance premiums among citizens in both formal and informal sectors. This research explored citizens’ willingness to allocate a portion of their income for insurance and identified the factors influencing their decision to enroll. By understanding these dynamics, the Ministry aims to tailor the scheme to be more inclusive and financially accessible for all residents.

The third study was a community health network mapping and assessment of barriers to healthcare and health insurance across Ekiti State, supported by GIZ. This assessment focused on identifying structural and logistical obstacles communities face in accessing healthcare services and enrolling in health insurance. The mapping aimed to pinpoint gaps in healthcare infrastructure and highlight specific challenges that prevent people from accessing essential services.

Collectively, these studies provide the Ministry with a comprehensive understanding of the healthcare needs and obstacles facing Ekiti State residents. The data gathered will be instrumental in shaping policies, enhancing service delivery, and improving healthcare access, ensuring that Ekiti State’s health system is responsive to its communities’ unique challenges and needs.

National Demographics Health Survey’s Indices for Performance 

All these above stated indices were supported by the recently released 2024 National Demographic Health Survey, which also highlighted Ekiti State Performance. 

When it comes to teenage pregnancy, there has been a significant decrease in the proportion of teens (aged 15-19) that get pregnant in the past four years in Ekiti State, which has implications for improved maternal and child outcomes, thus contributing to socio-economic progress by increasing educational attainment. 

As against 2019 and 2024, more women have access to family planning, which leads to healthier outcomes and enables women participate better in the workforce. 

Also within the same period of review, there has been an increase in health facility deliveries as more women are delivered of their babies by a skilled birth attendant, thus reducing neonatal mortality and promoting strengthened health system. 

Also, the proportion of children aged 12 to 23 months, who have received child survival vaccines has significantly increased compared to five years ago, thus protecting them from life threatening diseases and even death. 

Excitingly, Ekiti has significantly improved the early childhood mortality indices in the past five years, which is a reflection of the quality of care and nutrition offered.

Through these initiatives, the Ekiti State government has undoubtedly, cultivated  focused on accountability, accessibility, and proactive healthcare in its efforts in disease prevention, resource management, and community engagement, which perhaps reflects a deep commitment to building a healthier, safer Ekiti State while setting a standard for effective public health governance.