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The Adamawa Primary Health Care System

The Adamawa Primary Health Care System. Dr Abdullahi Dauda Belel Chairman, Adamawa SPHCDA, Nigeria 23 rd April 2014. Presentation Outline. Background Information PBF Introduction Progress in implementation Results What’s Responsible?. Background Information.

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The Adamawa Primary Health Care System

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  1. The Adamawa Primary Health Care System Dr Abdullahi Dauda Belel Chairman, Adamawa SPHCDA, Nigeria 23rd April 2014

  2. Presentation Outline • Background Information • PBF Introduction • Progress in implementation • Results • What’s Responsible?

  3. 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

  4. 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) In Nigeria, Health centers suffer from underlying systemic issues • 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

  5. 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

  6. 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

  7. PBF Introduction

  8. 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

  9. 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

  10. Minimum Package of Activities

  11. Complimentary Package of Activities

  12. Results

  13. Increase coverage across the 3 PBF States Institutional Delivery Nasarawa Ondo Adamawa Assumption: Estimated crude birth rate (per 1000 pop): Adamawa (51), Nasarawa (38), Ondo (32)

  14. Quality scores are converging at high level but still have variations across states Quality Score (%) Ondo Nasarawa Adamawa

  15. Significant improvement has been observed in many areas, with a few areas of consistently low scores From (2011) To (2013) Nasarawa Adamawa Ondo

  16. 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

  17. Thank you PLEASE VISIT US @: http://nphcda.thenewtechs.com & http://adsphcda.org.ng

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