By KATE HAWKINS, Future Health Systems member

STEPS Centre affiliate, the Future Health Systems Research Programme Consortium, is currently meeting in Abuja, Nigeria. Future Health Systems is an international partnership to research and communicate innovations that improve access to quality healthcare for the poor. The meeting has provided an opportunity to bring together private sector innovators and entrepreneurs who are helping to shape the Nigerian health system.

Dr Oluyombo A. Awojobi runs a private primary health care clinic in Ibarapa. The meeting heard how he is using innovative technologies to overcome structural difficulties to provide an acceptable, quality and accessible health service to people in his locality. His clinic runs under testing circumstances. There is no public electricity supply, no municipal water supply and transport is expensive and unreliable. To overcome these challenges Awojobi, a surgeon by profession, has become an inventor and manufacturer of low cost technologies many of which harness natural resources. Awojobi believes that several functional small devices are better than one big device as they cut down on capital, outlay, repair and maintenance.

Overcoming the challenge of a lack of electricity and water
Awojobi has designed his clinic to take full advantage of natural light. There are large windows in the operating room so that they can operate without artificial light during the day. Basins above the operating tables concentrate the light at night.

At night the clinic is illuminated by homemade lamps with rechargeable dry cells. These are charged by the generator during the day and 40 lamps are attached to a car battery at night.

The clinic has a heating furnace which runs on maize cobs. Bio gas made from poultry droppings and cow dung takes the place of kerosene.

The clinic also utilises bought in solar panels. This technology is difficult to replicate as it requires silicone but Awojobi and his apprentice, his son, are looking at how they could do something similar using tin.

To provide a water supply for the clinic Awojobi and colleagues have dammed the stream that runs through the hospital grounds and built wells. They built a ventilation improved pit. VIP, latrine to get over the problem of a lack of water for flushing cisterns.

Building infrastructure and manufacturing medical technologies
A lack of building infrastructure and clinical supplies are often cited as a major barrier to health service access. Awojobi and colleagues have built their own buildings and roads. This was made easier through the creation of a mobile cement mixer fabricated from the rear axle of the car and which revolves 360 degrees in the horizontal plane.

Medical technologies manufactured at the clinic include;
• Wooden operating tables.
• A hematocrit centrifuge fashioned from the rear wheel of the bicycle and that does not rely on a generator.
• A pedal suction pump made out of a bicycle valve.
• A tricycle and village ambulance made out of a motorcycle.

The team have made a water distiller so they have been producing their own saline since 1984. To date they have manufactured over 54 430 litres of normal saline solution, over 3 550 units of acid citrate dextrose solution and about 1 900 liters of 25% dextrose solution. The cost of this has been 10% of that charged on the open market.

The clinic has been running for 25 years and their model has been taken up by others. Despite having published in various journals and trying to communicate and promote his innovations they have not reached the prominence that Awojobi would have liked. They have not been taken up by government and taken to scale. Despite this he remains hopeful about the future of health care in Nigeria,

‘If there are 100 problems in Nigeria then Nigerians can solve them without stepping out of this place. If we can do it with health we can do it with anything.’

For more details contact: Dr. Oluyombo A Awojobi, Awojobi Clinic Eruwa. P O Box 5, Eruwa, Oyo State Nigeria. Phone: +234 802 420 1501 Email: [email protected]