Appropriate Technologies for Improved Rural Health Care Delivery in Developing Countries - The Ibarapa Experience by Oluyombo A Awojobi

*University of Ibadan Ibarapa Community and Primary Health Programme – 1963 FIRST IN THE WORLD!! *World Health Organization Alma Ata Declaration – 1978 1978 - ‘Health For All By 2000’ 2000 - ‘MDG’s 2015’ 2008 – ‘Return to Basics’

*University of Ibadan

Ibarapa Community and Primary Health Programme – 1963

FIRST IN THE WORLD!!

*World Health Organization

Alma Ata Declaration – 1978

1978 - ‘Health For All By 2000’

2000 - ‘MDG’s 2015’

2008 – ‘Return to Basics’

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA CASE SCENARIO A PREGNANT WOMAN REGULAR ANTENATAL CARE GETS ALL PROMOTIVE AND PREVENTIVE CARE SUDDENLY AT TERM, SHE STARTS BLEEDING. RUSHED IN THE VILLAGE AMBULANCE TO THE NEAREST GENERAL/DISTRICT HOSPITAL RESIDENT PHYSICIAN PERFORMS A CAESAREAN SECTION DELIVERS A LIVE HEALTHY BABY(IES) AND A SURVIVING MOTHER.

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA

CASE SCENARIO

A PREGNANT WOMAN

REGULAR ANTENATAL CARE

GETS ALL PROMOTIVE AND PREVENTIVE CARE

SUDDENLY AT TERM, SHE STARTS BLEEDING.

RUSHED IN THE VILLAGE AMBULANCE TO THE

NEAREST GENERAL/DISTRICT HOSPITAL

RESIDENT PHYSICIAN PERFORMS A

CAESAREAN SECTION

DELIVERS A LIVE HEALTHY BABY(IES) AND A SURVIVING MOTHER.

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA NIGERIAN BASELINES NO PUBLIC ELECTRICITY SUPPLY NO MUNICIPAL WATER SUPPLY EXPENSIVE AND UNRELIABLE TRANSPORTATION

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA

NIGERIAN BASELINES

NO PUBLIC ELECTRICITY SUPPLY

NO MUNICIPAL WATER SUPPLY

EXPENSIVE AND UNRELIABLE

TRANSPORTATION

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA APPROPRIATE TECHNOLOGY - SCIENTIFICALLY SOUND, - CULTURALLY ACCEPTABLE SEVERAL FUNCTIONAL SMALL DEVICES ARE BETTER THAN ONE BIG DEVICE (CAPITAL OUTLAY, REPAIR AND MAINTENANCE) - GENERATORS, - WATER PUMPS AND - WATER RESERVOIRS MAXIMAL USE OF NATURE - NATURAL LIGHTING - RAIN WATER HARVESTING AND STORAGE - BIOGAS FROM POULTRY DROPPINGS/COW DUNG FABRICATION OF BASIC HOSPITAL EQUIPMENT IN-HOSPITAL PRODUCTION OF MATERIALS

25 YEARS OF PRIMARY CARE SURGERY IN IBARAPA

APPROPRIATE TECHNOLOGY

- SCIENTIFICALLY SOUND,

- CULTURALLY ACCEPTABLE

SEVERAL FUNCTIONAL SMALL DEVICES ARE BETTER THAN ONE

BIG DEVICE (CAPITAL OUTLAY, REPAIR AND MAINTENANCE)

- GENERATORS,

- WATER PUMPS AND

- WATER RESERVOIRS

MAXIMAL USE OF NATURE

- NATURAL LIGHTING

- RAIN WATER HARVESTING AND STORAGE

- BIOGAS FROM POULTRY DROPPINGS/COW DUNG

FABRICATION OF BASIC HOSPITAL EQUIPMENT

IN-HOSPITAL PRODUCTION OF MATERIALS

Rain Water Collection From Clinic Rooftop

Earthen Dam at ace

Coal Heating Furnace

Africa Health 1994; 16: 17-19

Africa Health 1994; 16: 17-19

Diagram of Water Distiller Trop Doct. 1993; 23: 173-174. prize-winning project - the National Agency for Science and Engineering Infrastructure

Pedal Suction Pump

Haematocrit Centrifuge Trop Doct 2002; 32: 168

IMPORTED N175 000.00 + GENERATOR N10 000.00 = N185 000.00 ace centrifuge N25 000.00 CENTRIFUGE

IMPORTED N175 000.00

+ GENERATOR N10 000.00

= N185 000.00

ace centrifuge N25 000.00

Diagram of a Haematocrit Centrifuge

Local Production of Intravenous Fluids IV fluids locally produced as described by Maurice King Production to date: Over 54 430 litres of normal saline solution Over 3 550 units of acid citrate dextrose solution About 1 900 liters of 25% dextrose solution Produced at 10% of the cost in the open market Nig. Med. Pract . 1985; 10:119.

IV fluids locally produced as described by Maurice King

Production to date:

Over 54 430 litres of normal saline solution

Over 3 550 units of acid citrate dextrose solution

About 1 900 liters of 25% dextrose solution

Produced at 10% of the cost in the open market

Nig. Med. Pract . 1985; 10:119.

Histopathology service

Histopathology service

Keke Eruwa: Autonov-3

SINCE JANUARY 1987 WHEN CLINIC WAS THREE MONTHS OLD NO EMPLOYER, NO EMPLOYEE MONTHLY FINANCIAL MEETING OF ALL MEMBERS OF STAFF ALL ON SALARIES KNOWN AND APPROVED BY ALL. ANNUAL INCREMENT. WELFARE SCHEME (GRATUITY) OPERATIONAL SALARY BILL OF N1.2 MILLION/MONTH IN THE LAST 3 YEARS NO RETAINERSHIP SUSTAINED BY FEES PAID BY PATIENTS NO SUBVENTION FROM ANY SOURCE WE ARE NOT INDEBTED TO ANY BODY, CORPORATE OR INDIVIDUAL

SINCE JANUARY 1987 WHEN CLINIC WAS THREE MONTHS OLD

NO EMPLOYER, NO EMPLOYEE

MONTHLY FINANCIAL MEETING OF ALL MEMBERS OF STAFF

ALL ON SALARIES KNOWN AND APPROVED BY ALL. ANNUAL INCREMENT. WELFARE SCHEME (GRATUITY) OPERATIONAL

SALARY BILL OF N1.2 MILLION/MONTH IN THE LAST 3 YEARS

NO RETAINERSHIP

SUSTAINED BY FEES PAID BY PATIENTS

NO SUBVENTION FROM ANY SOURCE

WE ARE NOT INDEBTED TO ANY BODY, CORPORATE OR INDIVIDUAL

I Thank You All for Your Kind Attention Oluyombo A. Awojobi , MB, BS, (Ibadan), FMCS (Nig). January, 2009.

‘ YES, WE CAN!!’ - BARACK OBAMA 5 TH NOVEMBER 2008