The Adamawa Primary Health Care System

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

6. 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

7. 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

8. PBF Introduction

9. 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

10. 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

11. Minimum Package of Activities

12. Complimentary Package of Activities

13. Results

15. 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)

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

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

18. 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

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