the adamawa primary health care system dr abdullahi dauda belel chairman, adamawa sphcda, nigeria 23...
TRANSCRIPT
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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
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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Demsa
Fuf ore
Gany e
Girei
Gombi
Guy uk
Hong
Jada
Lamurde
Madagali
Maiha
May obelwa
Michika
Mubi North
Mubi South
Numan
Shelleng
Song
Toungo
Yola North
Yola South
PBF Introduction
PBF
PBF scale up
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
Increase coverage across the 3 PBF States
Adamawa Nasarawa OndoInstitutional Delivery
12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 120%
10%
20%
30%
40%
50%
60%
Assumption: Estimated crude birth rate (per 1000 pop): Adamawa (51), Nasarawa (38), Ondo (32)
Adamawa Nasarawa Ondo
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Qu
ality
Score
(%
)
Q4 '11
Q1 '12
Q2 '12
Q3 '12
Q4 '12
Q1 '13
Q2 '13
Q3 '13
Q4 '13
- 10 20 30 40 50 60 70 80 90
100
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51
66 64
45
57 66 67 67
21
65
81 84 83 83 87 86 85
41 52
69 67 70 65 66 68
76
Quality scores are converging at high level but still have variations across states
Adamawa Nasarawa Ondo
From (2011) To (2013)
Significant improvement has been observed in many areas, with a few areas of consistently low scores
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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