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?
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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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