EU/UNICEF Support to Adamawa MNCH
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Transcript EU/UNICEF Support to Adamawa MNCH
The Adamawa Primary Health Care System
Dr Abdullahi Dauda Belel
Chairman, Adamawa SPHCDA, Nigeria
23rd April 2014
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Presentation Outline
Background Information
PBF Introduction
Progress in implementation
Results
What’s Responsible?
2
Background Information
Adamawa State is located in Northeast of Nigeria
Projected 2014 Population of 3,87m
Has 21 LGAs and 226 Wards
Among the 5 poorest States in Nigeria
A major contributor to the Nigeria’s poor health indicators
Health sector has very minimum private sector
participation while the public facilities are in a deplorable
State
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In Nigeria, Health centers suffer from underlying systemic issues
What you will see at a primary health care center:
• Relatively abundant workers (among top in SSA)
• Chronic stock-outs of essential drugs (Avg. 55%)
• Lack of minimum equipment (Avg. 25%
equipped)
• Poor sanitation/waste management
• Idle health workers/absenteeism (Avg. 29%)
• Correct mgmt. of maternal complication (17.3%)
• No patients (Avg. 1.5 patients per day)
Underlying systemic issues:
• Fragmentation and poor coordination between
federal, state and local govt levels
• Unclear accountability and poor performance
review to strengthen it
• No incentives to good or poor performance
• No cash and autonomy at health facilities
Source: Service Delivery Indicator (SDI) Survey, 2013
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Background Information
The entire sector is currently under reform, using PBF as a
strategy
The State is piloting PBF for GON but adopted it as strategy
for strengthening the health system
Focused primarily on strengthening the Ward Health System
(WHS) and Primary Health Care Under One Roof (PHCOUR)
Ensuring that funds are made available at the service points,
guided by deliberate and focused plans
MNCH is placed at the frontline in PBF design and its scale
up is supported by EU-UNICEF
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Background Information
Implementation arrangements is aligned to the
attainment of the NSHDP’s objectives
Pre-Pilot evaluation revealed encouraging results and
further clarified areas for immediate and long term
adjustments for the scale up
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PBF Introduction
Madagali
Michika
Mubi North
Hong
Mubi South
Gombi
Shelleng
Maiha
Song
Guy uk
Lamurde
Girei
Numan
Demsa
Y ola North
Y ola South
Fuf ore
May obelwa
Jada
PBF
Gany e
PBF scale up
Toungo
DFF
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Progress in Implementation
Key Officers: SMOH, ADPHCDA trained on PBF In
Mombasa-Kenya and Enugu-Nigeria
Pre-Pilot (Fufore LGA) was chosen
Rural LGA – Pop ~ 240,160
Political Wards: 11
A Cottage Hospital (Secondary HF)
Baseline assessment of HFs and Communities done
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Progress in Implementation
15 HFs selected: 14 HCs for MPA & 1 GH for CPA
Management structures at LG level constituted and
inaugurated (2012)
LG RBF Steering Committee
WDCs
HF RBF Committees (both HCs & Hospital)
IMC (both HCs & Hospital)
Bank Accounts for both HCs & Hospital opened
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Minimum Package of Activities
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Complimentary Package of Activities
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Results
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Increase coverage across the 3 PBF States
Institutional Delivery
Adamawa
Nasarawa
Ondo
60%
50%
40%
30%
20%
10%
0%
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Assumption: Estimated crude birth rate (per 1000 pop): Adamawa (51), Nasarawa (38), Ondo (32)
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Quality scores are converging at high level
but still have variations across states
Quality Score (%)
100
90
80
70
60
50
40
30
20
10
-
65
52
51
41
84
81
69
66
83
70
67
64
83
87
86
65
57
66
68
67
85
76
67
45
26
21
Q4
'11
Q1
'12
Q2
'12
Adamawa
Q3
'12
Q4
'12
Nasarawa
Q1
'13
Q2
'13
Ondo
Q3
'13
Q4
'13
Significant improvement has been observed in many areas,
with a few areas of consistently low scores
From (2011)
To (2013)
Adamawa
Nasarawa
Ondo
What’s Responsible?
Many factors but mainly
Political will supporting change by the State Governor
Having clear institutional arrangement with separation of
functions
Having PHC Under One Roof and empowering the PHC
Agency with autonomy
Strong mentoring (and WB TA support) and follow-up
programme by the SPHCDA using the PBF Manual
Autonomy given to the facilities to improve their staff
strength, engage communities and utilize cash to solve
immediate needs
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Thank you
PLEASE VISIT US @:
http://nphcda.thenewtechs.com
&
http://adsphcda.org.ng
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