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. 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-AAA

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
PBF
PBF scale up
DFF

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
Adamawa
Nasarawa
Ondo
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
Adamawa
Nasarawa
Ondo

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