Optimising access to basic diagnostic primary care in Nigeria

Kelechi Prince Chima (Nigeria & Trinity 2023) is a medical doctor and a second year DPhil student in clinical medicine at the Nuffield Department of Medicine.

Tell us about yourself

My name is Kelechi Prince Chima, and I was born, raised, and trained in Nigeria. My ancestry traces to the warm and hospitable people of Obollo-Afor in Enugu State and the enterprising people of Arondizuogu in what is now known as Imo State. 

I study health system access, specifically how to measure it and optimise health systems to maximise equitable access for people in resource-constrained settings, particularly in sub-Saharan Africa. I’m also an avid digital graphic designer and a footballer. 

What drove you to your area of study? 

I’d say it stems from my experiences participating in and coordinating medical outreaches during medical school. As part of my undergraduate humanitarian organisation, the Medical Research and Humanitarian Society, we undertook numerous outreaches to rural and underserved areas in south eastern Nigeria, providing diagnostic and therapeutic care for prevalent communicable and noncommunicable diseases. I was always somewhat discontent with (though still respectful of) the idea of treating one patient at a time, when simple tools like the partograph (a basic paper record that helps health workers safely manage labour) could potentially save generations of lives. 

My clinical experience further solidified these views, as I was often overwhelmed by the futility of late-stage or severely limited care for many patients. This was often due either to infrastructural constraints within my hospital such as limited access to advanced diagnostics and interventions, or to broader systemic challenges, where the health system struggled to meet the preventive needs of many Nigerians, particularly those for whom illness could mean financial catastrophe. Both were causes I found myself powerless to change from my position as a single health worker within a wider system. 

Witnessing these limitations, both in rural outreach settings and in clinical practice, made my inclinations more urgent and more clearly defined. It ultimately led me to pursue postgraduate education in global health, so that I could better understand how to conceptualise and implement simple, scalable, and effective healthcare interventions.

Tell us more about your research 

My work focuses on measuring and optimising spatial access to basic diagnostic care at the primary care level, using Nigeria as an illustrative case study. 

To do this, I use spatial analytical techniques to assess both the availability of, and accessibility to, diagnostic services (via road networks) for prevalent conditions such as malaria, tuberculosis, and diabetes at primary healthcare centres across Nigeria. I complement these analyses with frontline perspectives from health workers at selected centres, to better understand real-world constraints and gather practical suggestions for improvement. 

Alongside insights from national and regional decision-makers, I aim to apply optimisation algorithms to support more efficient and equitable resource allocation, ultimately helping to maximise diagnostic coverage across primary healthcare centres nationwide. 

What do you hope to be the next steps of your work? 

In the immediate term, I hope to support Nigeria’s primary healthcare agency in allocating resources within its ongoing primary care revitalisation initiative. The aim is for the optimisation algorithms to inform the selection of primary healthcare centres, as well as the specific revitalisation packages assigned to them, in order to equitably maximise access to basic diagnostic care. 

In the longer term, I hope the insights from my work can practically inform similar approaches adopted by national governments in other resource-constrained settings. Beyond healthcare, I also hope this work can support more effective resource allocation to improve access to public education, financial services, and other essential infrastructure.