1. Nafada General Hospital Staffing – 4 doctors and 16-17 nurses – Of the nurses, 8 are in the combined female, paediatric and maternity ward rotating on 3 shifts per day and 4 of which have undergone previous training on inpatient management of severe acute malnutrition – Other trained nurses (5) are in the male ward

2. Nafada General Hospital Equipment, Infrastructure and Medicines – Combined female, paediatric and maternity ward has 23 beds, 2 of which are in a small isolation room – F75 and F100 is available in the hospital but is not administered to admitted malnourished children – At time of visit, other medications needed for management of sever acute malnutrition not available

3. Nafada General Hospital Assessment – Infrastructure-wise, hospital has the bed capacity to accommodate severe acute malnutrition patients. – Staff trained in management of severe acute malnutrition are either not practising their skills or are not effectively utilised – Whilst F75 and F100 are available, they are not administered to admitted malnourished children. Other required medications are not available and need to be purchased by patients

4. Nafada General Hospital Recommendations – In-house refresher training and mentoring for doctors and nurses of hospital through a national consultant on management of severe acute malnutrition – Review of nursing roster and reassignment of trained staff to the paediatric ward ensuring that each shift has a trained nurse on duty – Need to ensure that required medications are available

5. Nafada OTP Clinics Birin Fulani Birin Bolewa Nafada Central Jigawa Barow Winde

6. Nafada OTP Clinics Staffing – Birin Fulani has 6 clinic staff – Birin Bolewa has 6 clinic staff – Nafada Central has at least 6 clinic staff – Jigawa has 5 clinic staff – Barow Winde has __ clinic staff

7. Nafada OTP Clinics Staff Training and Capacity – All OTP Clinics have at least 5 clinic staff who have undergone orientation training on the 26 th and 27 th of September conducted by UNICEF international consultants – Practical on-the-job mentoring was also provided for all trained staff during one-day set-up and one-day follow-up – Staff capacity varied across the clinics but in each site, there are staff who are good in anthropometry, those good in clinical assessment and those good in both

8. Nafada OTP Clinics Equipment, Infrastructure and Medicines – All OTP clinics had relatively adequate infrastructure – However, availability and accessibility of clean water (including drinking water) is an issue – Whilst all clinics have tabletop infant weighing scales, Salter scales which are most ideal for weight measurement were unavailable – Required medications were not immediately made available to the OTP clinics during the set-up days and the distribution is problematic

9. Nafada OTP Clinics Set-up Days – Birin Fulani on 28 September 2009 – Birin Bolewa on 29 September 2009 – Nafada Central on 30 September 2009 – Jigawa on 1 October 2009 – Barow Winde 2 October 2009

10. Nafada OTP Clinics Admissions during set-up days – Birin Fulani – 14 admissions (10 M, 4 F); 2 sent for inpatient care – Birin Bolewa – 25 admissions (15 M, 10 F); 3 sent for inpatient care – Nafada Central – 16 admissions (8 F, 8 M); 1 sent for inpatient care – Jigawa – 31 admissions (19 F, 12 M); 3 sent for inpatient care – Barow Winde – 21 admissions; 1 sent for inpatient care

11. Nafada OTP Clinics Issues during set-up days – During set-up for Birin Fulani, Birin Bolewa and Nafada Central, required medications were not readily made available. OTP clinics in these sites which should have started by 9 am only received medications 3 hours later – Clean water is an issue in all sites but more so in Jigawa given its distance from the nearest town where clean drinking water can be bought – Some clinic staff have openly asked for additional extra salary for their work in the OTP clinics

12. Nafada OTP Clinics Follow-up Days

13. Nafada OTP Clinics Assessment - Staffing – There are clinic staff who have easily gained practical and clinical skills required for OTP and with continued mentoring will for sure be able to conduct the programme well. Also, the LGA nutritional focal point who was in all the set-up and follow-up days has gained excellent practical competence in the OTP and will be ideal for supervisory and mentoring role in all sites – However, based on first week admissions, it is highly likely that the numbers will just go higher weekly. Hence, current staffing capacity of each clinic might prove inadequate and needs to be reviewed

14. Nafada OTP Clinics Assessment – Equipment, Infrastructure, Medications – Access to clean water is an issue in all OTP clinics – Availability and ready-access to required medications is questionable

15. Nafada OTP Clinics Recommendations – Current staffing OTP clinics should be reviewed based on week-on-week admissions to assess whether additional staffing is required. In the meantime, other aspects of the OTP clinic such as anthropometry and appetite test can be handled by existing community volunteers so that clinic staff can focus on clinical assessments – LGA should find means to be able to provide clean water to each OTP sites on a regular (at least weekly during admission days) basis – LGA should ensure that required medications are available to OTP clinics and distributed on time