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

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

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 Shun Source: Service Delivery Indicator (SDI) Survey, 2013 LON-AAA123-20110705-

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

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

PBF Introduction PBF PBF scale up DFF

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

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

Minimum Package of Activities

Complimentary Package of Activities

Results

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

Quality scores are converging at high level but still have variations across states Adamawa Nasarawa Ondo

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

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