Abia State was created on 27th August 1991 from the old Imo State with its capital at Umuahia. The state is located in the southeastern region of Nigeria and covers an area of about 5,834 sq. km - approximately 5.8 percent of the total land area of Nigeria. The state is bounded on the North and Northeast by the states of Anambra, Enugu, and Ebonyi. To the west of Abia is Imo State, to the East is Cross River State and Akwa Ibom State, and to the South is Rivers State. The Southern part of the state lies within the riverine part of Nigeria. It is a low-lying tropical rainforest with some oil-palm brush. The state is inhabited (mostly 95% of the population) by the Igbo ethnic group who are predominantly Christians. According to the National Population Commission 2016 projection, Abia State has a population of 4.1 million. The population is projected to grow at a national growth rate of 3.6% per annum, meaning that the state will have a population of about 5.1 million in 2023. The state is governed by a governor and has 17 LGAs and 21 ministries headed by Chairmen and Commissioners respectively. Abia State has 184 wards.

Agriculture is the major occupation of the people of Abia State. Subsistence farming is prevalent and about 70 of the population is engaged in it. The main food crops grown are yam, cassava, rice, cocoyam and maize while the cash crops include oil palm, rubber, cocoa, banana, and various types of fruits. There are three agricultural zones in Abia State: Aba, Umuahia, and Bende. Modern poultry like the Golden project at Ogwe in Ukwa LGA has been introduced and is practiced by a good number of people. Furthermore, Abia State is blessed with enormous mineral resources such as Crude Oil, Natural Gas, Lead, Zinc, and Copper. Others include Gypsum, Limestone, Iron Ore, Kaolin, Industrial sand, and igneous rocks. Several medium-scale industries abound in parts of the state, which produce such items as plastic wares, textiles, food processing, and machine tool fabrication.

The State has one of the highest levels of education in the country with over 800 primary schools, 160 secondary schools, one teacher training college and five technical colleges. There is also a College of Education (Technical) at Arochukwu. Other higher institutions in the state are the Abia State University at Uturu in lsuikwuato LGA, and the Abia State Polytechnic at Aba. In addition, the government provides a staff training school at Urnunnato in Bende LGA. A Federal University of Agriculture at Umudike, lkwuano LGA, by the Federal Government. Other educational institutions include Schools of Nursing and Midwifery in Abiriba, Aba and Umuahia. Also a world class agricultural research institute is located at Umudike (NRCRI). A School of Midwifery is attached to the Methodist Hospital, Amachara, while the School of Health Technology at Aba trains various categories of health staff (i.e. health superintendents, rural health superintendents, community midwives, health assistants, and community health assistants). A School of Psychiatric Nursing is located in Mgboko (Obingwa LGA). A Youth Opportunity Centre at Umueleghele in Isiala Ngwa LGA has been established to enable school drop-outs and unemployed youths to acquire vocational skills. Vocational training for the disabled is provided by the Marist Brother’s Hopeville Rehabilitation Complex at Uturu and Umuahia. Facilities there include workshops for making shoes, wheels and prostheses.

Besides education, the state also has several tourist attractions sites like The Long Juju of Arochukwu; The Azumini Blue River; The Amakama Wooden Cave and many other Caves. Other areas of interest are the National War Museum and Ojukwu Bunker and The Museum of Colonial History. The main centres of cultural attraction are the famous traditional “Akwete” cloth weaving, Ugwuabia Festival and The Ohafia War Dancers.

The main occupations in Abia are trading (mainly small-scale businesses), farming (subsistence) and employment in the state civil service. The state is endowed with natural resources and there are vast amounts of arable land and a good number of streams. With its adequate seasonal rainfall, Abia produces yams, maize and potatoes, cassava and rice among many other crops. Up to 70% of the population are involved in agriculture which contributes 27% of the state GDP. Another major contributor to the GDP of the state is crude oil and gas production with 39% of the GDP (Abia State Bureau of Statistics). Despite these, economic development has been relatively poor due to the collapse of infrastructure, environmental degradation and unregulated exploration. Specifically, owing to poor infrastructure and energy challenges, the manufacturing sector accounts for only 2% of GDP. Electricity supply to the state from the national grid is poor and irregular with the attendant impact on the health and well-being of the people of the state. The consequent dependence on generators affects both personal economies and health care provision.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2 Health Status of the Population
The commonly occurring non-communicable diseases include hypertension, arthritis, pneumonia other cardiovascular diseases and diabetes. For communicable diseases, state prevalence of malaria, hepatitis, HIV/AIDS and tuberculosis remain high. Nutritionally, a high proportion (20.5%) of the under-fives are stunted. For adolescent and young persons STI, sanitary care, personal hygiene and Gender-based violence remains the prevailing healthcare challenges.

2.3 Overview of the Health System
The Abia health care system is structured across 3 levels: primary, secondary and tertiary. The state has 2 tertiary health facilities, 15 state general hospitals located across the 17 L.G.A’s and   687 public primary health care centers located in every ward in all the L.GA’s (currently managed by the local government authorities). Healthcare delivery can be classified into two; public and private healthcare services. The public health care facilities are 687 (ABSPHCDA 2017) in number while the private facilities are 236 (SMOH, medical services) in number and these are located mostly in semi-urban and urban areas. There are also 11 training institutions including a Federal Medical Centre.

In spite of the above-mentioned structures in place, healthcare service delivery still remains a huge challenge, leading to poor health indices in the state. The tertiary and secondary health facilities in the state are in comatose; Currently, the health workers in secondary and tertiary health facilities ie (Hospital Management Board- HMB and Abia State University Teaching Hospital- ABSUTH) respectively are owing monthly salaries of over 24 months; in the last 4years, workers of these institutions had gone on strike for over ten times and are currently on strike. This brought about a huge healthcare deficit in the state. Federal Medical Centre Umuahia the only tertiary health facility in the state is grossly overburdened and this invariable will likely affect the quality of care in the facility if not properly addressed. Most worrisome is the high level of out-of-pocket expenditure for  medical bills and services viz-a-viz the high cost of accessing  private own health facilities which is predominant in the state, as the state do not have a  robust health insurance scheme; less that 2% of the state population are under health insurance coverage.

Key actors in Abia state health system include the formal and informal actors: Formal actors include Federal Government of Nigeria, Abia State Government, Ministry of Health and other line ministries. Health and health-related agencies, such as; ABSACA, SPHCDA, State Assembly, Civil Society(s), Research institutes, development partners. Informal actors include PSO, WDC, Faith based organization, professional bodies and Philanthropists. However, the government has not lived up to her responsibility to drive the process, hence the weak coordinating mechanism in the Abia Healthcare delivery system.

2.4 HEALTH SERVICES, PROVISION AND UTILIZATION
Abia State Government through the Ministry of Health has the responsibility for secondary and tertiary health care; while the local government has the responsibility for the primary health centers and health posts in their wards. The State Ministry of Health plans and develops health programs and supervises implementation along the national health policy guidelines. The Ministry of Health through the hospital management board provides secondary health care services. The Ministry also through the Abia State Primary Health Care Development Agency provides policies and guidelines for primary health care service delivery and supervises its implementation in the 17 Local Government Areas.

Available health service performance indicators include full immunization coverage at 34% with children that have not received any immunization (zero doses) placed at 5.4%; Stunting in Under 5 children at 20.5%; Diarrhea in children is 2.5%. TFR is 5.1% (MICS 2016), Use of the modern FP method by married women 15-49 is 9.5% (any method 16.6%); delivery by skilled attendants is 43.0% while facility-based delivery is 37.6%. Other service indicators are ITN ownership as 59.6%, ITN utilization at 23.5% for under-five year children and 18.9% of pregnant women; Malaria treatment (any anti-malarial drug) is 42.5% for under-five children and 17.6% of pregnant women took IPT at least once during their ANC visits.  Knowledge of HIV is 98.6% among females and 99.2% among men. Knowledge of TB is 97.0%. While it remains a daunting task to get data for measurable indicators on secondary healthcare and non-communicable diseases.

The health sector has witnessed a high attrition rate of healthcare workers. Incidentally, only the state teaching hospital (ABSUTH) trains about 75 doctors a year and if this is not properly and timely addressed, there will be a health crisis in the state.

GENERAL LIMITATIONS
Some of the limitations to Abia health system are;

1. High out-of-pocket expenditure for medical services, (95%) and this brings about avoidable death among individual who cannot afford it

2. Medical services are relatively expensive and not subsidize

3. Abia is predominantly rural dwellers with merger income and increased dependence ratio

4. Poor Funding of health facilities resulting to a deficit of basic and modern equipment

5. Weak infrastructures

6. Difficulty in accessing most of the health facilities  

7. The paucity of relevant baseline data

8. Weak data management system, which makes accessibility of data a difficult task

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9. Poor feedback mechanism, among the key players in the Abia State health system
 

10. Perennial industrial disharmony (Strike actions)

AREAS OF FOCUS DURING THE MEDICAL MISSION
Abia state is in dare need of intervention in virtually all prongs of healthcare services, so no intervention could be seen as irrelevant or waste, however, if one has the opportunity to prioritize of there are areas that will be of more burdensome that the other in terms of age and sex disaggregation and geographical location. In view of the statement above the focus of the medical mission may graciously be as follows;

CATEGORY 1- ADULTS AND AGED

• Hypertension and other Cardiovascular Diseases

• Arthritis

• Diabetics

• Malaria

• Pneumonia

• Cancer

CATEGORY 2- ADOLESCENT AND YOUNG PERSONS

• STI

• Sanitary care and personal Hygiene

• Malaria

• Gender Base Violence

• Psychosocial support

CATEGORY 3- NEONATAL/INFANT AND CHILD CARE

• Sepsis

• Malaria

• Diarrhea

• Pneumonia

• Common cold

• Allergy

CATEGORY 4- MATERNAL CARE

• Quality antenatal care

• Skill birth attendant/management of birth complication

• Post-natal care

CATEGORY 5- SPECIAL INTERVENTION

• Support ongoing Public Health intervention in the state- TB, HIV, Child malnutrition, immunization/ vaccination, Neglected tropical diseases.

• Scale of Laboratory service and pharmaceutical care

• Other Special intervention from Labademic missions not listed.

APPENDIX

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