Health workers are receiving orientation training for the hub and spoke health systems in Nigeria.eiving o

Maternal and Child Health

Hub and Spoke Healthcare Delivery System

June 24, 2020

by Guest Contributor

By Dr. Johnson Diara, Rural Health Services of Sudan United Mission/Nigeria Reformed Church

A Unique Way of Reaching Our Target Population

The Nigeria health system is skewed to favor the urban Nigerian communities with less than 30% of the country’s population and low disease burden. Most of the effects of socio-demographic factors on health are very minimal in the urban areas when compared to rural areas where the uneducated and poor face an obvious absence of basic amenities and social services. It was on this basis that Rural Health Services was established to take care of both the physical and spiritual needs of the rural people in Nigeria.

Faced with the challenges of meeting the health and spiritual needs of a vast population laden with a high disease burden and wide geographical spread, we adopted the hub and spoke healthcare delivery system, making our organization unique and distinctive from other healthcare service organizations in the country. This healthcare delivery system helped us to meet the target population’s needs and improve the health of the population as well as provide succor to their spiritual needs through our “gospel in stethoscope.”

This program was founded by the Netherlands Reformed Congregation and is implemented in South East and North Central Nigeria under the auspices of Rural Health Services of Sudan United Mission/Nigeria Reformed Church. Rural Health Services (SUM/NRC) is a self-sustaining facility-based program, but has support for projects in TB and HIV/AIDS. In this time of COVID-19 we are still using our skills to serve the Lord in the rural areas of Nigeria.


Flow chart of Rural Health Services and how the organization is structured.

Key Terms:

SUMSHT-Sudan United Mission School of Health Technology
SUMHs-Sudan United Mission Hospitals
SU3Ms-Sudan United Mission Medical Missions

Rationale for Hub and Spoke System of Healthcare Delivery
  • Impossible terrains
  • Vast Population
  • Wide geographical coverage
  • High disease burden
  • Poor road network
  • Poor economic status
  • Poor access/utilization of services
THE HUB is located at the headquarters in Onuenyim and services rendered at the hub include:
  • Administration, including management of organization’s resources
  • Human Resources
  • Financial Management
  • Material Management
  • Referral centre
  • Capacity building
  • Management of primary and secondary cases.

Visual of the hub and spoke system of health delivery, including the hub in the center which is where administration function is, surrounded by spokes delivering care.

THE SPOKES are located in our 7 satellite hospitals spread over Ebonyi and Benue States

Services rendered at the spokes:

  • Management of primary cases and emergencies
  • Basic emergency obstetric centres
  • Immunization centres/points
  • PMTCT sites
  • Point for anti-TB drug collection
  • Point for distribution of other consumables by the state and federal governments
  • Daily devotions with patients in the ward and OPD

Health workers attend to patients in a maternity ward in Nigeria.

OUR STRENGTH-things we possessed that helped us to make the implementation possible
  • SUMSHT provided us with needed manpower
  • SU3Ms provided the platform to launch into new frontiers with the gospel and medical care –a new centre is usually born through this
  • Monthly supportive supervision from the headquarters
  • Monthly clinical meetings
  • Quarterly meetings with leaders

Health workers are receiving orientation training for the hub and spoke health systems in Nigeria.eiving o

  • Brought healthcare to people’s doorsteps
  • Increased utilization of healthcare services
  • ANC uptake increased by 200% between 2008 and 2013
  • Facility delivery increased by 130% between 2008 and 2013
  • Immunization for childhood diseases increased by 250% between 2008 and 2013
  • Timely interventions
  • Planted over 15 viable churches and strengthened uncountable numbers through our “Gospel in Stethoscope”

From 2008 to 2013, we experienced:

  • Maternal and child mortality was 65% lower
  • Under 5 mortality was 70% lower
  • Death due to tropical diseases and emergencies was 75% lower
  • Death due to TB & HIV/AIDS was 70% lower
  • MTCT (mother-to-child transmission of HIV) was 70% lower


Health Team Members in Daily Morning Prayer Devotion.

  • Capital intensive and demands a lot of discipline and sacrifice
  • Infrastructure
  • Maintaining the manpower
  • Providing for the patients with the very meager out of pocket payment from them
  • Logistical problems

We achieved beyond our mere imaginations through the adoption of Hub and Spoke healthcare delivery system. It wasn’t easy but it’s worth the result we got. The impact was massive and we are thankful to God for His enablement despite the rough wide terrain of the rural Nigerian communities.

See more about faith-based organizations and health systems strengthening.

About the Author: Dr. Johnson Diara is the director of Rural Health Services of Sudan United Mission/Nigeria Reformed Church –An organization founded by the Netherlands Reformed Church. He is a project Coordinator for HIV/AIDS projects funded by the Center for Disease Control (CDC), a consultant for MCSP (USAID/JHPiego) on Pre-service education in Maternal Newborn and Adolescent Care, a trainer for USAID/JHPiego on Gender-based Violence and Health Workers for Change, a consultant for USAID/MAPs on Health System Management.

Dr. Diara has an MBBS, MPH, a Diploma in Healthcare System Management, a Certificate in Health Policy and System, and a PhD in Public Health, as well as United Nations and Johns Hopkins Bloomberg School of Public Health training in humanitarian assistance. 

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