I was pleased to join the UNHCR at the 36 Million Solutions: Africa Private Sector Forum on Forced Displacement throughout the week. From my important high-level yet candid bilateral conversation with UNHCR Deputy High Commissioner, Kelly T Clements, to joining Michel Sidibé of the Africa Union Special Envoy for The African Medicine Agency, Dr. Githinji Gitahi – CEO Amref Health Africa, Diana Mulili – Chief Growth Officer at Xetova and Nancy Moloantoa of Open Society Foundation on the panel for Inclusive Health Systems – The Only Way, this week highlighted the importance of uniting Africa’s business and industry leaders with philanthropists, refugee change-makers, and the public sector when designing market-based approaches to leverage the potential and power of the 36 million solutions who are forcibly displaced across our continent.
Africa hosts the largest number of forcibly displaced persons worldwide: 36 million. 36 million families and neighbours. 36 million customers and suppliers. 36 million innovators, entrepreneurs, and employers. The intimate forum and gathering hosted by the UNHCR was a unique opportunity to inspire and encourage African-led solutions to the issues of forced displacement across our continent.
As an advocate for healthcare – I was pleased to join the panel for Inclusive Health Systems – The Only Way. Every person deserves the right to dignified healthcare, regardless of their migration status. Yet, health systems too often fail forcibly displaced people, who already face numerous obstacles in accessing high-quality care. COVID-19 has exposed the inequities in healthcare and the reality that its delivery cannot be separated from the unique economic, cultural and social circumstances of communities in need.
African countries have historically opened their borders and hearts to families fleeing war, violence, conflict, or persecution. Countries that receive and host refugees, often for extended periods, make an immense contribution from their own limited resources to the collective good and to the cause of humanity.
In Nigeria for example, we have 3 million people internally displaced and another 74,000 refugees and asylum seekers. Many of these people have been in this situation for years, and greater support and services are required to help them rebuild their lives.
Along with this, we have a population of 206 million people with nearly half living below the poverty line. These numbers may give us insight, but they often fail to tell the full story of the dire situation that has befallen so many due to the lack of universal health care or access to healthcare that can allow people to live longer, increase their incomes, and lead to positive socio-economic gains for their families.
The major constraint of our current system is that vulnerable people usually lack the funds to pay for healthcare. Health care financing in Nigeria is mainly through out of pocket payment, and most people cannot afford to pay. Another challenge we face is the quality of health care available in most rural communities. The system is very weak, even our best hospitals have poor infrastructure, with few properly trained personnel, very little equipment, and a lack of sustainable medications supply model. Combining both of these with a lack of education surrounding maternal health, creates a critical and urgent situation for many women, children and vulnerable people in Nigeria.
My Wellbeing Foundation Africa has operated for close to 20 years with a set of 10 core rights-based principles to improve the health and wellbeing of childbearing women and their newborns. We believe that we must support a call to mobilise resources to deliver the same standard to the women and children of Nigeria, and refugee and displaced communities:
These core rights-based principles should be universal in healthcare alongside an accessible and inclusive health care system. We also ought to recognise the roles that cultural, economic and social access to healthcare play at large – in other words, the social determinants of health, from conception and birth to age.
I have always made it a priority to ensure that the needs of women and families are met, and respected without taking away from what they are culturally and socially familiar with. This is particularly important for women and families who have very limited choice when it comes to where they live, survive and thrive, yet I also recognise that many communities possess the knowledge of what they want and need, to save and nurture lives.
In addition to this, I have always believed in the Midwife and the Nurse being at the frontline, and at the centre of women-centred care – after all, they understand womens’ anatomy and women’s biological processes best – we should empower and equip midwives and nurses, as caring community professionals, to empower others accordingly.
The flagship program of my Wellbeing Foundation Africa is MamaCare360*. We currently run from 31 cluster hubs across Kwara, Lagos, Osun and Kaduna States, and the Federal Capital Territory of Abuja with a cumulative daily attendance of at least 2,000 women per state and more than 230,000 repeated contacts to date. As a result of this continuum, we have been able to increase pregnant women’s antenatal care attendance to the WHO LMIC recommendation in 8 visits during pregnancy and puerperium at each healthcare facility.
From a maternal and general public health perspective, the continuum of care concept must include every child, woman and family in its definition; irrespective of their socio-economic background, commitment, consistency and the lack thereof. My Wellbeing Foundation Africa’s Mamacare360 Program is hinged on the model and practice of a community comprehensive care and continuum of care. From conception to birth, to cradle and right through to age, a true continuum (and access to) of care is afforded every woman – irrespective of social and eco-determinants.
MamaCare360* takes a whole community approach from the hut and household to the health facility, ensuring women have the knowledge, skills and confidence to deliver safely, nurture and nourish their children, improve their economic prospects, and be a rights-based partner in a healthier national, and therefore global outcome – in other words, our women can be the key drivers of our attainment of the Sustainable Development Goals.
Migration Health must also be conceptualised and actualised here in order for true equity and accessibility to occur. How do we welcome and ensure one central education and personal health record system that will ensure a true continuum of care in all of the directions required?
As childbirth is a universal process that does not respect circumstances – all of my work is focused on safer births and better early childhood development within a routinely delivered health, education, gender and social paradigm that includes nutrition, WASH, and SGBV-SARC dimension – essential services that are needed more by those forced to flee or suffering from poverty.
Every refugee and vulnerable person deserves their rights to health guaranteed in any host location, powered by health-enhanced certifiable identities. Health costs, accessibility and eligibility should not be included on the list of the acclimatisation of deprivation that displaced people should have to consider.
Policymakers, thought-leaders, governments and CSOs have received the perfect chance to re-organise and realign the ways in which the concept of ‘delivery’ becomes actualised across a plethora of sectors. But from an advocacy, community-centred service and support function perspective, we must dive deeper and further to ensure that truly, no one is left behind.
That is why I call on the private sector in Africa. Our private sector has often been at the forefront of creating solutions that lift thousands of marginalized and underserved communities out of abject poverty. Unfortunately, often enough forcibly displaced people who represent some of the most vulnerable communities on the continent, are overlooked and therefore do not fully benefit from the innovative solutions and social investment programs spearheaded by the private sector in Africa.
Therefore, with this knowledge and the aid of the UNHCR and their forum, Africa’s private sector is positioned to be a critical agent of change. As investors in refugee-hosting communities, as partners, donors or employers, the private sector must continue to increasingly step into the humanitarian relief space to support innovative responses to the urgent and critical needs of the vulnerable communities.