title: Prospects of using Community Directed Intervention strategy in delivering health services among Fulani Nomads in Enugu State, Nigeria.
abstract: BACKGROUND
  The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads.
  
  
  METHODS
  This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area.
  
  
  RESULTS
  Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises.
  
  
  CONCLUSIONS
  Given the definable organizational structure of the nomads in Enugu State and their desire for modern health intervention, it is feasible to test the CDI strategy for equitable healthcare delivery among nomads. They are willing and capable to participate actively in their own health programmes with minimal support from professional health workers.
authors.affiliation: Department of Immunization and Vaccine Development, WHO/AFRO, Brazzaville, Congo. okeibunorj@afro.who.int
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Okeibunor
authors.forename: Nkechi G
authors.initials: NG
authors.lastname: Onyeneho
authors.forename: Obioma C
authors.initials: OC
authors.lastname: Nwaorgu
authors.forename: Ngozi
authors.initials: N
authors.lastname: I'Aronu
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Okoye
authors.forename: Felicia U
authors.initials: FU
authors.lastname: Iremeka
authors.forename: Johannes
authors.initials: J
authors.lastname: Sommerfeld
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009549:Nigeria; D036301:Qualitative Research; D014171:Transients and Migrants; D055815:Young Adult