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By Ngozi Nwoke
Adaeze Oreh is a consultant family physician, public health specialist and the immediate past Commissioner for Health in Rivers State, Nigeria.
In this interview with Saturday Sun, she shared achievements recorded in the River State Ministry of Health by the current Sim Fubara administration in which she served as commissioner.
What specific strategies did you implement to address the high maternal mortality rate in Rivers State while you were the Commissioner for Health?
At the time Governor Fubara was inaugurated in 2023, Rivers State had incredibly high maternal mortality rates. This was the backdrop against which we had to develop the state’s #Health4AllRivers strategy. We quickly realised that tackling poor population health outcomes like maternal deaths would require a holistic and comprehensive approach.
Therefore, our health strategy encompasses pillars such as geographical and financial access to quality health services, access to essential medicines and commodities, human resources for health, health security and emergency preparedness and response, domestic resource mobilisation, health information and health systems leadership and governance.
These are essential elements towards addressing maternal health. Envisioning pregnant women and nursing mothers in local government areas (LGAs) such as Ahoada West, Akuku-Toru, Andoni, Bonny, Emohua or Etche having functional primary healthcare facilities, benefiting from emergency medical ambulances (on both land and sea), having been enrolled for financial access through the state’s health insurance scheme, meeting skilled personnel at the centres with readily available medicines, vaccines and other commodities, having their health data recorded for care, learning and decision-making, with collaborative community ownership of these facilities and responsive leadership to both commendation and criticism. This is the #Health4AllRivers vision for the women of our state.
We established ‘Maternal Mondays’ at the ministerial level, where every single maternal death in any LGA is reviewed to determine root causes and implement context specific decisions to prevent similar recurrences. Also, just this month, the national Maternal and New-born Mortality Innovation Initiative (MAMII) was activated in Rivers State, with field visits to all the six LGAs with the highest rates of maternal deaths. Today, Rivers State’s maternal mortality rates have declined by almost 50 per cent to 248 per 100,000 live births.
How did you improve healthcare infrastructure in the rural areas?
Over the past 30 months, three zonal hospitals of 105-bed capacity each have been completed by the Rivers State Government. The first, Zonal Hospital Bori, which was commissioned on the 12th of March 2025, served as a referral centre for primary and smaller secondary healthcare facilities in Rivers South-East Senatorial district which encompasses Andoni, Eleme, Gokana, Khana, Opobo/Nkoro, Oyigbo, and Tai Local Government Areas.
Strategic rural health system efforts showed health facility attendance in Rivers South-East increased by nearly 60 per cent from about 589,000 patients to nearly 1 million between 2022 and 2024. Zonal Hospital Ahoada, commissioned on the 23rd of December 2025, served the Rivers West Senatorial District which comprises many riverine communities in Abua/Odual, Ahoada East, Ahoada West, Akuku Toru, Asari Toru, Degema, and Ogba/Egbema/Ndoni Local Government Areas; and neighbouring LGAs such as Emohua.
Over the last 26 months, health facility attendance in Abua/Odual, Ahoada East, Ahoada West and Emohua has increased by nearly 200 per cent from about 400,000 patients to nearly 1.2 million in 2025. Additionally, deliveries increased by 40 per cent, skilled birth attendance by 60 per cent, and four antenatal care visits attended by 20 per cent, most notably in Ahoada East.
In the coming months, the completed Zonal Hospital Omoku which caters to Ogba-Egbema-Ndoni Local Government Area (ONELGA) will also be commissioned. This area covering 918.5 km² has a population density of 443.6/km², is also in Rivers West Senatorial District, and borders Imo, Delta, Bayelsa, and Anambra states.
It is known for its oil-rich, primarily agrarian, and fishing-based economy, composed largely of Ogba, Egbema, and (my own) Ndoni ethnic groups. From a population of about 250,000 in the 2006 census, the population has almost doubled to 400,000. Other ongoing rural secondary-level projects include Zonal Hospital Okehi in Etche Local Government Area, Zonal Hospital Bonny, and the recently approved General Hospital Oyigbo, the first-ever general hospital in Oyigbo Local Government Area.
These are distinct from the nearly 200 primary healthcare centre renovations in communities such as Luuwa, Kaani-Babe, Queens Town, Egberu, Opobo, Elekahia, Rumuodomaya, Ahoada, Miniamah, Okwuzi, Okochiri, Onne, Akpajo, MPHC Rumuolumeni, Omagwa, Sama, Obuama, Aminiowere, Island Maternity Fiberesima, Akinima, Mbiama, Bonny, Tema, Oyigbo, and Kpean that have occurred over the past two years through regularly deployed state investment and in collaboration with the National Primary Healthcare Development Agency (NPHCDA) and the World Bank.
Can you elaborate on the progress you made in implementing the Basic Healthcare Provision Fund (BHCPF) in Rivers State? How has it impacted healthcare access for vulnerable populations?
The Basic Health Care Provision Fund (BHCPF) in Nigeria was something that I personally felt quite invested in, because in the run-up to its eventual roll-out in 2017, I belonged to a horde of unrelenting advocates for its implementation as a route to universal health coverage (UHC). This national programme through 1% of the Federal Consolidated Revenue Fund, donor grants, and other sources, and which was established (though not immediately implemented) by the National Health Act (2014) was in effect across Rivers State’s primary healthcare, state health insurance and emergency medical gateways to ensure that vulnerable populations could access essential healthcare services such as primary care (PHC), maternal/child health, family planning, and emergency care.
Rivers State received designated funds from the National Health Insurance Authority (NHIA) to purchase essential services like antenatal care, delivery, immunization, and child health services; National Primary Healthcare Development Agency (NPHCDA) for PHC strengthening through essential drugs, equipment, facility maintenance, and human resources in Primary Health Centres (PHCs), and National Emergency Medical Treatment Committee (NEMTC) for urgent care needs. The programme focused on the poor and most vulnerable populations, including pregnant women, children under five, the elderly (60+), and people with disabilities. It provided care at no cost, and sought to achieve Universal Health Coverage (UHC).
What measures did you take to address the shortage of healthcare workers in Rivers State?
In 2024, Governor Fubara approved the employment of 2,000 healthcare workers to be deployed to rural secondary level hospitals and the Rivers State University Teaching Hospital. This is because with over 347 primary healthcare centres in the state, and staff attrition that have occurred over the years, there was a critical need to enhance the human resources available to provide skilled basic healthcare services at our various communities.
Additionally, state-sponsored scholarships are in place to fund the training of medical doctors, nurses, medical laboratory scientists, physiotherapists, radiotherapists and other allied health workers. This was directed at generating a consistent pipeline of healthcare workers available in the state. More so, the unlocking of about 12 years of stagnated civil service promotions and payments of arrears have also bolstered staff morale.
The government’s staff retention strategy focused on staff welfare, and therefore included shoring up staff numbers, upwardly reviewing salaries and allowances, funding regular training for skills-building and capacity development in collaboration with multiple institutions. We were mindful of the burdensome workload of clinicians and propensity for burnout, chronic fatigue and poor mental health, in RSUTH, the state teaching hospital.
How did the Rivers State Ministry of Health leverage technology to enhance disease surveillance and response mechanisms, and what were the outcomes?
The Rivers State Ministry of Health was dedicated to strategic digital innovation, in alignment with our #Health4AllRivers strategy. The primary objective was to enhance healthcare delivery through digital transformation, with strategic emphasis on Electronic Health Records (EHR), telemedicine & mobile health, Health Information Management Systems, and data-driven decision making. Two major digital platforms were launched to enhance quality health service delivery – Riv-HealthReg, which is a digital platform for registering and regulating healthcare facilities, thereby enhancing efficiency, transparency, and accountability in facility oversight; and MedixTrak which is a Hospital Management Information System (HMiS) that streamlines hospital administration, improves patient care, and reduces errors.
We digitised health records and transitioned from paper-based systems to electronic health records (EHRs) across primary, secondary, and tertiary facilities. Interoperability and integration are paramount, and so we developed platforms that allow seamless exchange of data across ministries, departments, and partner organisations. For real-time disease surveillance and reporting, early warning systems for outbreaks and disease trends were empowered using GIS-enabled and mobile-based tools.
For infections such as mpox, the team at the Rivers State Institute for Infectious Disease Research and Development came up with an Artificial Intelligence (AI) – powered tool which enabled swift clinical diagnosis for community-level healthcare workers and surveillance officers, thus significantly reducing disease notification times.
What are the key challenges that faced the healthcare system in Rivers State, and how did you address them?
First off, when people think of Rivers State, what comes to mind is either oil and gas or politics. What many fail to realise is the vastness of the state in terms of human capital, with a population of nearly 9.5 million, 71 per cent of whom are rural-dwelling, diverse terrains across both upland and riverine communities, and six hard-to-reach LGAs. Of these six LGAs, four of them account for almost 70 per cent of our highest burden LGAs for maternal deaths. Within the state’s health system, there are 1274 health facilities, 71 per cent of which are private, and 95 per cent are primary healthcare centres. From this background, clearly, the health sector is quite vast and complex.
Therefore, scaling health policies was quite challenging, leaving us to come up with innovative methods to implement various public health policies for state-wide implementation. Another challenge was meeting community expectations and demands. As I mentioned earlier, out of 347 PHCs in Rivers State, over the past two years, nearly 200 have been renovated, upgraded, and in some cases newly built.
This leaves about 147 PHCs in other communities clamouring for their own PHC revitalisation efforts. Whilst the need may be there, the resources are severely limited. This is similar at the secondary level, where seven zonal/general hospitals have and were being refurbished and newly built, leaving 15 other hospitals not yet attended to.
So, managing those community needs and expectations were quite challenging, required enormous tact, diplomacy, and the nurturing of development partner relationships that can help. I must say, though, that our various community leaders proved to be exceptionally understanding and supportive in this regard.
How did you ensure that healthcare services were accessible and affordable for all residents of Rivers State, particularly those in hard-to-reach areas?
Asides from rural revitalisation of health facilities, one landmark decision of Governor Fubara’s administration was the implementation of the Rivers State Contributory Health Protection Programme (RIVCHPP) in 2024, three years after the law was passed in 2021. This was the social health insurance scheme established by the Rivers State Government to provide universal access to quality, affordable healthcare for all residents.
Its benefits included affordability with the availability of voluntary enrolment for an annual premium of approximately ₦25,000 per year, providing comprehensive coverage for preventive care, hospitalisation, specialised treatments, and essential drugs. At the time of implementation of RIVCHPP, out-of-pocket spending was greater than 90 per cent based on our findings from a state-wide household survey. Imagine how financially crippling that would have been.
However, with the state’s health insurance scheme, out-of-pocket costs drastically reduced, thereby protecting families from financial hardship, as enrollees typically only paid 15 per cent of drug costs at the point of service. Also, through the scheme, which specifically targeted vulnerable populations through the Basic Healthcare Provision Fund (BHCPF) and state equity plans, there was zero payment at service points for eligible beneficiaries who included pregnant women, children of 5 years, the elderly, and indigent, persons with disabilities and persons living with HIV/AIDS. Therefore, ensuring that healthcare services are accessible and affordable for all residents of Rivers State, particularly those in hard-to-reach areas relied largely on investments to scale the enrolment of the populace to financially cover millions of lives in the state.
