Appropriate TechnologiesAppropriate Technologiesforfor

Improved Rural Health Care Improved Rural Health Care DeliveryDelivery

ininDeveloping CountriesDeveloping Countries

- The Ibarapa Experience- The Ibarapa Experience  

bybyOluyombo A AwojobiOluyombo A Awojobi

*University of Ibadan Ibarapa Community and Primary

Health Programme – 1963FIRST IN THE WORLD!!

*World Health OrganizationAlma 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

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

Rain Water Collection From Clinic Rain Water Collection From Clinic Rooftop Rooftop

Earthen Dam at Earthen Dam at aceace

Coal Heating Coal Heating FurnaceFurnace

Africa Health 1994; 16: 17-19

Africa Health 1994; 16: 17-19

Diagram of Water DistillerDiagram of Water Distiller

Trop Doct. 1993; 23: 173-174.

prize-winning project- the National Agency for Science and Engineering Infrastructure

Pedal Suction PumpPedal Suction Pump

Haematocrit CentrifugeHaematocrit Centrifuge

Trop Doct 2002; 32: 168

IMPORTED N175 000.00

+ GENERATOR N10 000.00

= N185 000.00

ace centrifuge N25 000.00

CENTRIFUGECENTRIFUGE

Diagram of a Haematocrit Diagram of a Haematocrit CentrifugeCentrifuge

Local Production of Intravenous Local Production of Intravenous FluidsFluids

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

Keke Eruwa: Autonov-3Keke 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

I Thank You All for Your Kind I Thank You All for Your Kind AttentionAttention

Oluyombo A. AwojobiOluyombo A. Awojobi, , MB, BS, (Ibadan), FMCS MB, BS, (Ibadan), FMCS (Nig).(Nig).

January, 2009.January, 2009.

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