Beyond Out-of-Pocket: A Hospital-Linked Fund is Helping Nigerians with Chronic Illness Access Care

Hospitals in New York improve healthcare quality and reduce medical costs by staying in frequent contact with patients requiring frequent or long-term care. Montefiore's Accountable Care Organization pulls in care providers from across the medical and social spectrum to improve patient health while curbing expenses.

Worker-owned home-care cooperatives are emerging as an alternative to the for-profit agencies that dominate America's direct-care sector. In these cooperatives, professional caregivers earn an average of $2 more per hour than the industry standard, share in business decision-making, and stay on the job at nearly double the rate of workers at traditional agencies. Patients also stay with co-op agencies twice as long, suggesting higher satisfaction and quality of care.

Clinica Amistad is a free, volunteer-driven primary care clinic addressing the healthcare access gap for uninsured and underinsured residents, particularly among the Hispanic/Latine community. Operating on $600,000 or less per year, the clinic offers a wide range of services, including chronic disease management, behavioral health counseling, and a Spanish-language pre-diabetes education program. In 2024, the clinic served 956 patients across nearly 2,500 visits, with patient volume growing 10% since 2017.

Since June 2024, Nigeria's National Health Insurance Authority (NHIA) has implemented a comprehensive fistula intervention program that fully covers transportation, surgery, feeding, post-operative care and follow-up services at no cost to patients. In Kano State alone, 2,157 women have received treatment through the intervention, with facilities handling 30-50 patients monthly, a significant increase from pre-program levels.

In 2017, residents of Kabuga Aisami in Kano built their own maternal and child health hospital to address maternal mortality rates and improve access to care. Led by the Kabuga Aisami Community Initiative (KACI), community members pooled resources to construct the facility, which includes two labor rooms, three wards with 40 beds, four laboratories, a pharmacy, 25 toilets, and three self-contained flats for doctors to enable 24-hour care. Patient volume has since increased by over 250%, and the hospital has expanded to serve 10 surrounding communities, as well.

A mobile diabetes clinic in Calgary brings comprehensive healthcare directly to people experiencing homelessness or low income at community health centers. The team provides services including foot care, retinal scans, blood and urine screening with immediate results, dietary counseling, and connections to housing and mental health programs. The "one-stop-shop" model eliminates the need for patients to travel to multiple appointments, ensuring they get the care they need.

Enugu State is addressing healthcare access gaps and high maternal mortality by establishing 260 Type 2 Primary Healthcare Centers, with 100 already completed. These fully-equipped facilities provide 24-hour care with essential medications and reliable utilities. As part of the initiative, the Centers are also recruiting 2,200 healthcare workers, training over 1,800 staff members in safe delivery and contraceptive methods, introducing AI-assisted ultrasound screening and implementing affordable health insurance. Since opening in March 2025, one center alone has served over 690 people.

The Abiye Project registered over 20,000 pregnant women using a community-based model to ensure they receive proper healthcare. The program connected women with trained health rangers who served as liaisons with traditional birth attendants (TBAs). When TBAs’ resistance stalled the program, the government introduced financial incentives, paying them for each patient referral, leading to more hospital births and a reduced child and maternal mortality rate.

Several doctors are working together to integrate oral health into medical checkups for children, pregnant women and others who can’t afford or access a dentist. With the help of a five-year, $6 million federal grant, a team of doctors and dental hygienists has trained 250 primary care providers in how to provide oral health care in several states, allowing patients to access dental care during regular checkups.

Since the Supreme Court overturned Roe v. Wade and individual states started passing strict abortion bans, groups like Aid Access, Hey Jane and Just the Pill began mailing abortion medications to women in states with bans. Six months after the Supreme Court decision, researchers saw an increase in women getting abortion medication outside of traditional healthcare settings. Aid Access alone reports mailing about 10,000 pills a month.