Community Health Extension Workers (CHEW) and Community officers in Lagos State, on Friday advocated a review to the extant Health Service Reform Law 2016, to legally authorise practitioners to own and operate private healthcare clinic.


Members of the CHEW, operating under the aegis of Association of Private Community Health Practitioners, made the proposition at a stakeholders parley organised by the Lagos State House of Assembly Committee on Health Service.

Speaking for the group, Mr Wole Jonathan, a licensed Community Health Officer in private practice, argued that most of CHEW members possessed required skills, experience on the job.

Jonathan said that community health workers were certified to operate community-based Public Health Care centres as afforded in the national health policy.

He said: “We should be allowed to use our certificates and license to own and operate private health care facilities.

“We are here on account of the state health reform law which allows other health care providers in the state – nurse, medical laboratory technician, pharmacy technician and others, that were trained by state government owned institutions, to work in government establishments and to use their license if they like to operate in the private sector.


“In the law, we observed that it is only the community health group – community health officers and the community extension health workers – that are not given any opportunity to operate; that was why we petitioned the House of Assembly to look into it.

“So, we are here today to plead that the Lagos Health Service Law be reviewed to allow us to own and operate private clinic and serve as operation officer because we have vital license to that effect.

“We have cited that even the law that affords for Primary Health Care centre, a law of Lagos State, recognize that the community health officer be in charge of government clinic.

“So, if one have the qualification which makes one able to be in charge of PHC, is the same qualification not liable to operate private clinic effectively?”

Also speaking, Dr Lateef Lawal, the Permanent Secretary, Primary Health Care Board, however, asked the body to rather go through their regulatory body and pressurise them for the desired inclusion to be effected at the National Assembly.

He said that this would make their demand seamlessly adhered to at the state level.

“There are no fears, the only reason for the agitation is because we have unemployment in the market and that is affecting everybody.

“If the government is able to absorb all the community health officers, there won’t be any call for this; they have their members who are out and unemployed who have to be catered for, so they have to think out of the box and say how can we actualise this?

“Our position is that we cannot be singing different tunes, we have the national body, the Federal Government, National Council of Health; they need to harmonize all the contending issues and it becomes a national act.

“If you have any opinion at all, it is easier to go to that council, argue your case out, they look at the merits and once it becomes a national law, it becomes easier for people like me to say okay this is the standard.

“Then we key into it, or else we would have a snowball effect where they will be agitating repeatedly,” he said.

Lawal called for increased funding to the health sector from the national budget as a way out of the unemployment problem.

“Nigeria is a signatory to the 2015 declaration, which makes it mandatory that 15 per cent of our national budget should be dedicated for health, but as at now the maximum you can probably get is between five and eight per cent.

“We say that health is wealth, education is also important, you can’t joke with the two, they may look intangible but they form the bedrock of any progress in the every society.

According to Mrs Abiola Idowu, Acting Executive Secretary of Health Facilities Monitoring and Accreditation Agency (HEFAMAA), the bone of contention was not the issue of ownership but operation.

Idowu said that care givers needed to be equipped with standard practice because of the importance attached to the life saving business.

“Currently, the law recognises their (CHEW) practice under the standing order under the auspices of a supervising physician that is what gives them the authority to use that order.

“Their cadre (community health practitioners) is not recognized under the health sector reform law of 2006 which establishes HEFAMAA, to operate centres.

“Each cadre is trained for specific purposes, doctors, nurses respectively, while the community health practitioners are trained to act as a linkage between the community and the health facilities.

“For them now to say they want to operate a facility, I don’t think their training qualifies them for that.

“We are saying they cannot work alone without supervision. We agree that they can work in private establishment due to dearth of nurses.

“Anyone can own a health facility but to run it we have a minimum standard in terms of basic amenities necessary to provide health care services,” she said.

Olusola Sokunle, Chairman, House Committee on Health, who summoned the stakeholders to the meeting, said that it was premised on a petition the group wrote to the Assembly for prompt intervention.

Sokunle and another member of the committee, Mr Noheem Adams, informed the stakeholders that the House would look at the matter critically and get back to the concerned group.


  1. There is going to be a serious problem between the CHEW and the doctors by the time the CHEW are allowed to own their private clinic.The CHEW is important but there is a clear difference between the doctors and the CHEW.It is important to be content with who you are and operate within your scope.

  2. If want to run a private clinic ,do the following:
    U will be free to own a private Clinic.
    Is it Chickens or Human beings u want to attend to ? If it’s Human Beings then still do the above….

    1. Actually, is true in the northern part of nigeria chew are giving license to open a private clinic in the village they are, so is not a problem in the north.

  3. Adeniji Adebimpe

    Hmmm,now that CHEWs want to have,their private clinic ,very soon, traditional birth attendant will fight for their own.

  4. For clarification, the CHO/CHEW’s are never trained to work under supervision of a medical doctor, it is the nurses who are trained to work under supervision of a medical doctor. CHO/CHEW’s are trained to manage patients where there is no doctor. This is a welcome development let’s keep pushing, l trust we will get there

    1. Point of correction, I believe your fight should be done with maturity, not with exchange of absurd and preposterous statement against nursing profession.

  5. It actually a misconception for someone to say CHEWs are trained to work under the supervision of a physician. In most of the PHC clinics in Nigeria, the law permits a CHO/CHEW to be the in charge, where I believe not all the Clinics has a physician attached to, so if they (CHEWs) are to work under the supervision of a physician that means work will not be done. And on the issue of Standing Orders, it is not stated in any procedure a physician should be there, it only stress the importance of referral whenever the case is above our limit which is a tradition in health care delivery. In Nigeria health system, we have the Primary, the Secondary and tertiary tiers with each tier manned with various cadres of health workers. In a country where majority of its population are rural dwellers if not because of Community Health Extension Workers her citizens will be in danger health wise. So Lagos State should think otherwise because Community health of today is uncomparable to the nurses.

  6. I believe if we all can take a bold step and come together we can achieve it not only in lagos but all over the country…thank you

  7. Yes as stated in someone’s comments. Chew are incomparable with nurses. While nursing is a profession that can function in any health care delivery systems the health extension workers are limited to preventive health. I would advise this agitators to limit their demand to what they are up to and never bring nurses into it.

Leave a Reply

Your email address will not be published. Required fields are marked *