For more than two decades, the leadership behind Healthcare Access Covenant Foundation has contributed to Nigeria’s Universal Health Coverage (UHC) movement through research, policy engagement, and published work on health financing and reform. Healthcare Access Covenant Foundation (HAC) now has been established to translate Universal Health Coverage from national policy aspiration into structured, community-level implementation. We align our work with Nigeria’s health sector reform agenda, the mandate of the National Health Insurance Authority, and the global UHC principles advanced by the World Health Organization. We make attainment of Sustainable Development Goal 3 our strategic goal. Our focus begins in Ekiti State, with the ambition to develop a scalable model for Southwestern Nigeria.  This can be franchised to cover entire Nigeria.

We are Moving Universal Health Coverage from Policy to People. Whoever doctors cannot reach, AI assisted Community Health Workers can reach them.

We want to ensure that the mother in rural Ekiti has the same access to equitable, evidence based primary health care as those in our national policy papers.

We want to ensure that vulnerable people are not subjected to catastrophic out-of-pocket medical expenditures as envisaged in the federal government policy papers.

We want to bridge the gap between national policy and rural dwellers by making every one of them to join a Mutual Health Association in their immediate neighbourhood so that Primary Healthcare services can be delivered to them neighourhood by neighborhood.

Our unique approach is to combine four mechanisms of a health system: health infrastructure, health personnel, health financing, people involvement,  into a Modular System that is sustainable, scalable and population focused.

We combine the following processes into an integrated Modular health system:

i, health financing, using membership contributions of Mutual Health Associations, operating as a cooperative organisation with a pre-paid health insurance premium,

ii, delivering health services using Modules of health personnel consisting of Community Key Workers, nurses and doctors, who are Task Sharing and Task Shifting, and having responsibility for a specified number of people,

iii, operating Open Walk-In AI Clinics in people's neighbourhoods

iv, involving local members of the community in several respects: In governance as members of Mutual Health Association Committees, as members of Clinical and Ethical Committees, in healthcare delivery by retired health personnel, or in social support by transporting ill people from the Clinics to hospitals, if necessary.

In this health system, the role of the people extends beyond going to the clinic for treatment. The system is designed to engender people ownership.

The data base of the enrolled members provide an anonymous fertile sample population for clinical and epidemiological research. 

Solar-Powered. AI-Assisted Mutual; Our Community-Owned, Mutual Medical Clinic, is bringing healthcare to the Last Mile.

The Problem We Are Solving

In rural Ekiti State, the nearest primary healthcare facility can be two to three hours away. Community health workers operate without diagnostic tools. Mothers deliver without skilled attendance. Hypertension and diabetes go undetected for years. Malaria kills children who could have been treated in hours.

This is not a failure of medicine. It is a failure of access to medicine.

RuralMind Mutual Clinic: The AI Clinics that provide answers.

A RuralMind AI Clinic is a solar-powered, AI-assisted diagnostic and consultation unit deployed directly inside rural communities, in the village square, in the community neighbourhood by neighbourhood where people already live.

Our Hub-and-Spoke facilities  have spoke clinics in rral areas linked to hub clinics at the centre. This brings together four technologies that individually exist, but have never been integrated at scale for rural Nigeria:

🤖 Artificial Intelligence Clinical Decision Support

An AI system guides trained Community Health Workers through patient triage, symptom assessment, and treatment protocols for the most common conditions in our communities — malaria, hypertension, diabetes, respiratory illness, and maternal health. It works offline, without internet connectivity. This is linked to the facility in the centre where patients can be referred.

🔬 Point-of-Care Diagnostics

Each clinic unit is equipped with portable diagnostic tools for malaria rapid testing, blood glucose measurement, blood pressure monitoring, urinalysis, and basic haematology — integrated directly with the AI platform so results inform clinical decisions in real time and triagging as indicated.

📡 Telemedicine Connectivity

When the AI flags a case that requires a qualified doctor, the system connects the community health worker and patient — live — to a physician at a hub of our faciities. No patient is left without access to medical expertise.

☀️ Solar Power

Every RuralMind Mutual Clinic is fully off-grid. Powered entirely by solar energy, it operates independently of Nigeria's electricity grid. No generator. No fuel costs. No interruption of care.

How It Works

Step 1 —  A Hub-and-Spoke network of WWalk-In primary health care centres are set up all over the State. The main Hub is in Ado-Ekiti. The Spokes are clinics in rural areas and deprived urban areas 

Step 2- Community Health Worker Activation

A trained Community Health Worker opens the spoke RuralMind Mutual Clinic at a scheduled clinic time. This offers Walk-In primary healthcare services.

Step 3 — AI-Guided Triage

The health worker enters the patient's symptoms into the AI interface. The system asks structured follow-up questions, analyses the pattern against clinical protocols, and recommends a course of action — from treatment at community level to urgent referral.

Step 4 — Diagnostics

Point-of-care tests are conducted where indicated. Results are captured automatically by the system. The doctor at the hub has immediate access to the results.

Step 5 — Treatment or Referral

The health worker follows the AI-recommended protocol, dispensing essential medicines within approved guidelines. If escalation is needed, a telemedicine call connects the patient to a registered nurse or a doctor, at the hub,  immediately.

Step 6 — Record and Learn

Every encounter is recorded. Over time, the dataset strengthens the AI model — making it smarter, more locally calibrated, and more accurate for subsequent patients.

The database provides sampling frame for clinical epidemiological studies.

What Conditions Does It Address?

Pyrexia: Diagnosis and treatment

        Malaria 

        Infections

            Upper respiratory tract

            Urinary tract

Hypertension — screening, monitoring, and medication management

Type 2 Diabetes — screening and glycaemic monitoring

Basic refractory errors for shortsightedness/long sightedness 

Maternal health — antenatal screening and danger sign detection

Mental health — basic screening and psychosocial support referral

Communicable disease surveillance

Minor injuries 

Childhood immunization 

Tetanus Toxoid 

Our Targets: Three Year Indicators

Target: 50 spoke RuralMind AI Clinics across Ekiti State

Patients reached annually: 200,000+ (Neighbourhood by Neighbourhood)

Community Health Workers trained: 200

Reduction in referral delays: 60%

Screening 100% of the population for high blood pressure and diabetes

Reduction in maternal mortality (project areas): 30%

Surveillance of population health to flag unusually common occurrences

Why We Are Different

Most rural health initiatives in Nigeria are built on outreach — a visiting team, a medical mission, a one-day medical camp, a temporary intervention. When the team leaves, the access gap returns.

RuralMind Mutual Health Association AI Clinics are permanent community infrastructure in rural areas. They are owned and governed by the community's own Mutual Health Association. They are financed through membership contributions, NHIA capitation payments, and institutional partnerships. They do not depend on donor goodwill to survive.

When we leave — the clinic stays.

Built for Replication

We are starting in Ekiti State. But we are building what Nigeria and Sub Saharan Africa can replicate.

Our full deployment toolkit covering hardware specifications, AI configuration, Community Health Worker training curriculum, and governance framework, will be openly published so that any organisation, state government, or community group can replicate this model without starting from scratch.

This is not a pilot. It is a prototype for universal replication.

We Align With Nigeria's Health Framework

RuralMind Mutual AI Clinics operate within and strengthen existing national systems:

National Health Insurance Authority (NHIA) — enrolled members qualify for capitation-based payments.

Basic Health Care Provision Fund (BHCPF) — state-level co-financing mechanism.

Technology Stack

Components.                             Platform.                             Cost Model

1, Electronic Medical Record.     Medplum (Cloud-hosted)   Available Free Tier

2, Patient Communication.     Twilio. (SMS+Whatsapp).       Pay-per-message

3,  Automotive Middleware.    Make (Integromat).                  Free, single clinic

4, AI Clinic Support.                 Claude/GPT-4o API.                Pay-as-go

5, AI Transcription                    OpenAI Whisper API.            Pay-as-go of audio

6, Appointment scheduling     Calendly.                                  Available Free tier 

7, Patient Data Form.                KoboToolbox.                       Free to NGO/health 

All platforms are cloud-based.            

We Are Professionals 

Our team have pre-requisite registrations:
Nigeria Community Health Practitioners Registration.

All Community Health Workers are registered and operate within their legally defined scope of practice

Nurse Council of Nigeria for nurses

Medical and Dental Council of Nigeria for doctors 

Partner With Us

RuralMind Mutual AI Clinics represent an investment opportunity for:

     State and federal government agencies

      Impact investors and development finance institutions

     Philanthropic foundations

     Diaspora donors committed to health equity in Nigeria

To discuss partnership, piloting, or funding, contact us at:

🌐 www.healthaccesscovenant.org/contact.html

PRIMARY HEALTHCARE-BASED UNIVERSAL HEALTH COVERAGE

Universal Health Coverage From Policy to People.

Healthcare Access Covenant Foundation (HAC) is developing a community-based model for translating Universal Health Coverage from national policy into practical access to quality, affordable primary healthcare at household and community level.

Our approach brings together community participation, Mutual Health Associations, pooled health financing, primary healthcare, community health workers, referral systems and appropriate digital technology into one connected healthcare ecosystem.

Household by household. Community by community.

[HOW THE HAC MODEL WORKS]

[PARTNER WITH HAC]

THE UHC CHALLENGE

Universal Health Coverage is more than having a health policy.

For Universal Health Coverage to become a reality, people must be able to obtain the healthcare they need without suffering financial hardship.

Yet many households continue to face barriers including:

Financial Barriers

The cost of healthcare can prevent people from seeking care early or expose families to financial hardship.

Limited Access

Many rural and underserved communities remain insufficiently connected to quality primary healthcare.

Fragmented Care

Patients may struggle to navigate between community services, primary healthcare facilities and higher levels of care.

The Last-Mile Gap

A national UHC policy does not automatically translate into healthcare access for an individual household.

The question is not whether Nigeria needs Universal Health Coverage.

The question is how we take UHC from policy to the household.

OUR ANSWER

Primary Healthcare-Based Universal Health Coverage

HAC believes that Universal Health Coverage should be built around strong primary healthcare, community participation and sustainable health financing.

Our model is designed to connect households to primary healthcare through community-based financing and organised healthcare networks.

ACCESS

Bringing essential healthcare closer to households and communities.

FINANCING

Pooling community contributions so that the financial burden of illness is shared rather than carried alone.

PRIMARY HEALTHCARE

Making primary healthcare the first and most accessible point of contact with the health system

CONTINUITY

Connecting community services, primary healthcare, referral care and follow-up into a continuous pathway.

COMMUNITY OWNERSHIP

Giving communities a meaningful role in organising, financing and sustaining their healthcare.

HOW THE HAC MODEL WORKS

From the Household to Universal Health Coverage

HAC brings together several components that are often treated separately.

HOUSEHOLDS

↓

MUTUAL HEALTH ASSOCIATION

↓

COMMUNITY CONTRIBUTIONS

↓

POOLED HEALTH FUND

↓

PRIMARY HEALTHCARE NETWORK

↓

HAC HUB + COMMUNITY SPOKES

↓

COMMUNITY HEALTH WORKERS

↓

REFERRAL WHEN NECESSARY

↓

CONTINUITY & COMMUNITY FOLLOW-UP

↓

UNIVERSAL HEALTH COVERAGE AT COMMUNITY LEVEL

The result is a model designed to connect people, financing and healthcare delivery rather than treating them as separate systems.

THE COMMUNITY IS PART OF THE FINANCING SOLUTION

Mutual Health Associations

At the heart of the HAC model is the Mutual Health Association.

A Mutual Health Association brings households together around a shared commitment to healthcare. Members make agreed contributions into a pooled health-financing arrangement that helps provide access to defined healthcare services.

Instead of waiting until an individual becomes ill and then expecting the household to bear the full cost, the community participates in risk pooling and collective health financing.

Member 1

Contribution

Member 2

Contribution

Member 3

Contribution

Member 4

Contribution

↓

COMMUNITY HEALTH FUND

↓

HEALTHCARE FOR MEMBERS WHEN NEEDED

This approach is based on a simple principle:

Everyone contributes. Those who need care receive care. The community shares the financial risk.

The Mutual Health Association therefore becomes more than a financing mechanism. It can also provide a platform for community participation, health education, accountability and collective action for better health.

HOW COMMUNITY CONTRIBUTIONS SUPPORT HEALTHCARE

From Contribution to Care

The HAC model is designed to connect financing directly with healthcare delivery.

MEMBER CONTRIBUTIONS

↓

POOLED COMMUNITY HEALTH FUND

↓

PRIMARY HEALTHCARE SERVICES

↓

REFERRAL SERVICES WHEN NECESSARY

↓

COMMUNITY FOLLOW-UP

↓

MONITORING & ACCOUNTABILITY

The objective is to create a transparent relationship between what communities contribute and the healthcare services they can access.

HAC's approach is intended to strengthen financial protection while supporting greater utilisation of appropriate primary healthcare.

THE HAC PRIMARY HEALTHCARE NETWORK

Bringing Healthcare Closer to Every Community

A central component of the HAC model is a Hub-and-Spoke Primary Healthcare Network.

The model connects a central healthcare hub with community-level healthcare points and community health workers, creating a structured pathway between households, primary healthcare and referral services.

REFERRAL HOSPITAL

                                ↑

                                |

                       ┌────────┴────────┐

                       │ HAC HUB │

                       │ │

                       │ Primary Care │

                       │ + Coordination │

                       └───────┬────────┘

                               │

             ┌─────────────────┼─────────────────┐

             ↓ ↓ ↓

          SPOKE 1 SPOKE 2 SPOKE 3

             ↓ ↓ ↓

       Community Community Community

       Health Workers Health Workers Health Workers

             ↓ ↓ ↓

          HOUSEHOLDS HOUSEHOLDS HOUSEHOLDS

The Hub

The hub provides a stronger primary healthcare base, coordination, clinical support, referral coordination and other functions required to support the network.

The Spokes

Spokes extend healthcare closer to communities and households, helping to overcome geographical and access barriers.

Community Health Workers

Community health workers provide an important link between households and the formal healthcare system.

Referral Hospitals

Patients requiring services beyond the capacity of primary healthcare can be referred to appropriate secondary or tertiary facilities.

TAKING PRIMARY HEALTHCARE THE LAST MILE

Community Health Workers

A health system cannot achieve UHC if people remain disconnected from it.

Community health workers can help bridge the gap between households and healthcare facilities.

Their roles may include:

FIND

Identifying households and people who may need healthcare, prevention or health information.

CONNECT

Connecting individuals and families to appropriate primary healthcare services.

EDUCATE

Supporting health education, prevention and healthy behaviours.

SUPPORT

Helping people navigate the healthcare system and encouraging appropriate care-seeking.

FOLLOW UP

Supporting continuity of care after facility-based treatment.

Through this community-level connection, HAC aims to bring primary healthcare closer to the people who need it most.

TECHNOLOGY THAT SUPPORTS PRIMARY HEALTHCARE

Extending the Reach of the Health System

Appropriate digital and AI-enabled technologies can strengthen the ability of community health workers and primary healthcare teams to reach underserved populations.

Within the HAC model, technology can support areas such as:

Community-level health information

Patient registration and enrolment

Health education

Early identification of health needs

Referral coordination

Follow-up and continuity of care

Data collection and reporting

Health-system monitoring

Technology is intended to support—not replace—healthcare professionals and community health workers, with appropriate clinical oversight, governance and protection of patient information.

FROM YOUR HOME TO THE RIGHT LEVEL OF CARE

A Connected Patient Journey

01 — HOUSEHOLD

A person or family member needs healthcare.

↓

02 — COMMUNITY HEALTH WORKER

The community health worker provides appropriate support and connects the household to care.

↓

03 — PRIMARY HEALTHCARE

The patient receives appropriate first-contact healthcare through the PHC network.

↓

04 — REFERRAL

If a condition requires a higher level of care, the patient is referred.

↓

05 — HOSPITAL / SPECIALIST CARE

The patient receives the appropriate secondary or tertiary service.

↓

06 — COMMUNITY FOLLOW-UP

The patient returns to the community and receives appropriate follow-up and continuity of care.

The objective is not simply to build more facilities.

It is to build a connected healthcare pathway around the patient.

UHC BEGINS BEFORE PEOPLE BECOME SERIOUSLY ILL

Prevention, Early Detection and Primary Care

Primary healthcare should not only treat illness. It should help communities prevent illness, detect problems early and maintain better health.

PREVENTION

Health education, vaccination, risk reduction and other preventive interventions.

EARLY DETECTION

Identifying health problems before they become more serious.

PRIMARY TREATMENT

Providing accessible, appropriate first-contact healthcare.

CONTINUITY

Supporting patients beyond the initial consultation or treatment.

WHAT MAKES THE HAC MODEL DIFFERENT?

Moving From Policy to Implementation

Traditional approach

HAC approach

Policy-led

Policy translated into community-level implementation

Facility-centred

Household + community + facility

Individuals bear healthcare costs when sick

Community-based risk pooling

PHC and financing operate separately

Financing linked to primary healthcare

Patients navigate the system alone

Community health workers help connect households

Referral can be fragmented

Structured referral and follow-up

UHC measured mainly at system level

UHC translated into household-level access

From measuring coverage...

...to making coverage real.

WHY MUTUAL HEALTH?

Community-Based Health Financing

HAC's Mutual Health Association approach is designed around several principles:

COLLECTIVE RESPONSIBILITY

Members contribute together towards a shared health objective.

RISK POOLING

The financial impact of illness is shared across the membership.

LOCAL OWNERSHIP

Communities participate in organising and sustaining their healthcare system.

FINANCIAL PROTECTION

Members have a mechanism designed to reduce the burden of unexpected healthcare costs.

ACCESS

Financing is linked to access to defined healthcare services.

ACCOUNTABILITY

Community participation creates opportunities for greater transparency and accountability.

WHY PRIMARY HEALTHCARE?

Because UHC Starts With First Contact

Primary healthcare is where most people's interaction with the health system should begin.

Strong PHC can provide:

Prevention

Health promotion

Basic diagnosis and treatment

Maternal and child health services

Immunisation

Management of common conditions

Chronic disease support

Community health services

Referral to higher levels of care

HAC's model therefore places primary healthcare at the centre of its approach to Universal Health Coverage.

STARTING IN EKITI STATE

Demonstrating the Model in Nigeria

HAC is developing its Primary Healthcare-Based UHC model in Ekiti State, Nigeria.

Ekiti provides an opportunity to demonstrate how community participation, health financing and primary healthcare strengthening can be brought together in a practical UHC implementation model.

The experience generated in Ekiti can provide evidence and lessons for adaptation and expansion in other communities and states.

FROM EKITI TO NIGERIA

A Model Designed to Scale

EKITI STATE

↓

LOCAL GOVERNMENT AREAS

↓

SOUTHWEST NIGERIA

↓

NIGERIA

HAC's ambition is not simply to operate a successful healthcare project in one location.

Our ambition is to demonstrate a practical, evidence-informed model that can be adopted, adapted and scaled.

The model is designed to evolve with the needs of communities, government health systems and healthcare partners.

MEASURING SUCCESS

How Will We Know the Model Is Working?

HAC intends to monitor outcomes across several dimensions of UHC.

COVERAGE

Households and individuals enrolled.

ACCESS

Use of appropriate primary healthcare services.

FINANCIAL PROTECTION

Reduction in the financial burden associated with healthcare.

QUALITY

Quality and continuity of healthcare services.

EQUITY

Reach among rural, underserved and vulnerable communities.

HEALTH OUTCOMES

Selected health and population-health indicators.

SUSTAINABILITY

Performance of community health financing and healthcare delivery mechanisms.

COMMUNITY OWNERSHIP

Strength and participation of Mutual Health Associations.

BUILDING EVIDENCE FOR UNIVERSAL HEALTH COVERAGE

From Implementation to Learning

HAC sees implementation and research as complementary.

RESEARCH

Generate evidence about community health financing, primary healthcare and UHC.

IMPLEMENTATION

Test the model in real communities.

LEARNING

Use evidence and community feedback to improve the model.

SCALE

Translate successful approaches into models that can be adapted elsewhere.

Our objective is not simply to implement a programme.

We aim to build evidence about what works—and how it can work at scale.

UHC CANNOT BE ACHIEVED ALONE

Partner With HAC

Achieving Universal Health Coverage requires collaboration between communities, governments, healthcare providers, researchers, technology partners and development organisations.

GOVERNMENTS

Partner with HAC to strengthen community-level implementation of UHC and primary healthcare.

DEVELOPMENT PARTNERS

Support evidence-based approaches to health financing, PHC access and financial protection.

COMMUNITIES

Organise households and participate in Mutual Health Associations.

HEALTHCARE PROVIDERS

Participate in an integrated primary healthcare and referral network.

TECHNOLOGY PARTNERS

Support responsible digital transformation of community and primary healthcare.

FUNDERS

Support demonstration, evaluation and scale-up of the model.

Let's move Universal Health Coverage from policy to people.

[PARTNER WITH HAC]

FOR COMMUNITIES

Affordable Healthcare Starts With a Connected Community

HAC is working to create a system in which communities can participate in organising, financing and accessing primary healthcare.

Interested in joining a Mutual Health Association?

[LEARN HOW TO JOIN]

[FIND A HAC LOCATION]

OUR VISION

Universal Health Coverage Does Not Begin at the Ministry.

It begins with the household.

HAC is working to move Universal Health Coverage from policy to people—household by household, community by community.

HEALTHCARE ACCESS COVENANT FOUNDATION

Primary Healthcare | Community Financing | Mutual Health | Universal Health Coverage | Evidence | Innovation

Nigeria • Ekiti State

[PARTNER WITH HAC]

[CONTACT HAC]

​"Moving from the Library to the Village Square"

​For over two decades, I have watched from the halls of academia as Health For All passed Nigeria by; as Nigeria failed to achieve any of the millennium development goals and as Universal Health Coverage, UHC, movement appears to be stagnating until a robust national mandate breathed life into it. With this new momentum, a question keeps haunting me: When will the mother in the rural settlement feel the impact of these policies?

​Healthcare Access Covenant Foundation (HAC) is my answer to that question.

​We are not here to reinvent the wheel. We are here to make it turn . We are in pursuit of Sustainable Development Goal 3.8. We espouse a solution to the last mile conundrum.

The challenge of the last mile is particularly stark in Ekiti ​despite a mandatory community health insurance scheme enacted into law in 2006. In Ekiti , we still see the life of a road traffic accident victim depending not on a functioning health system, but on the desperate, ad-hoc donations of his townsmen.

​We have documented the solution to the "last-mile" conundrum: The Strategic Path to Universal Health Coverage in Nigeria (ISBN 9789789611731) and Financing Universal Health Coverage in Nigeria (ISBN 9789789613724). We are now mounting non-party partisan but practical steps to bring policy to the reality of remote men and women in Ekiti; To vulnerable poor people in Ekiti; To everyone living below poverty line in Ekiti. 

 Why are starting in Ekiti? 

We have chosen Ekiti State as our starting point—not just because of its intellectual heritage, but also because of the alluring characteristics of the people of Ekiti people. These coupled with the excellent but forgotten law on mandatory community health insurance scheme that requires all residents to belong to a contributory scheme, make Ekiti a perfect laboratory for a scalable and self-sufficient model of primary health care based universal health coverage that we espouse.

​When we succeed in Ekiti, we provide a blueprint for all of Southwestern Nigeria, and indeed the whole of Nigeria.

Clarion call

​We invite you to join us. Whether you are a policymaker, a retired health worker, a government official, a traditional ruler, a neighbourhood high chief, a philanthropist, a donor or a grant administrator, your partnership with us is the final ingredient in translating "Health for All" from a long term slogan into an immediate lived reality for every Nigerian.

​Prof. Laofe Ogundipe, FRCPsych, London.

Founder, Healthcare Access Covenant Foundation