BASICS-N PROJECTBASICS-N PROJECTCommunity Partners for Health (CPH) Coalitions in Lagos, Community Partners for Health (CPH) Coalitions in Lagos,

NigeriaNigeria1994 – 19991994 – 1999

Sam A OrisasonaSam A OrisasonaTeam Leader, Lagos Field OfficeTeam Leader, Lagos Field Office

Order of PresentationOrder of Presentation

1.1. Project Mandate/TiltleProject Mandate/Tiltle2.2. The Critical Health IssuesThe Critical Health Issues3.3. Core ProcessesCore Processes4.4. ManagementManagement5.5. Logistical SupportLogistical Support6.6. TrainingTraining7.7. MembershipMembership8.8. Characteristics of CPHCharacteristics of CPH9.9. NetworkingNetworking10.10. AccomplishmentsAccomplishments11.11. Sustainability IssuesSustainability Issues

The Critical Health IssuesThe Critical Health Issues In 1990 immunization coverage in Nigeria approached the In 1990 immunization coverage in Nigeria approached the

African target of 80%African target of 80% Since 1991, immunization efforts have slackenedSince 1991, immunization efforts have slackened In 993, only 37% of children received all antigens by first In 993, only 37% of children received all antigens by first

birthdaybirthday In 1992, USAID documented 29% children with valid full In 1992, USAID documented 29% children with valid full

immunization coverage by 12 monthsimmunization coverage by 12 months In 5 LGAs where BASICS was to serve, immunization In 5 LGAs where BASICS was to serve, immunization

coverage was pegged at between 20.5% and 40.9%coverage was pegged at between 20.5% and 40.9% Physical accessibility was not much the problem, but, but Physical accessibility was not much the problem, but, but

lack of quality services by the public sector,lack of quality services by the public sector, Hence, BASICS was mandated to redress the problemHence, BASICS was mandated to redress the problem

Project MandateProject Mandate

PROJECTPROJECT: : USAID/BASICS-N Child Survival USAID/BASICS-N Child Survival PROJECTPROJECT

BASICS means Basic Support for BASICS means Basic Support for Institutionalizing Child Survival, Arlington, Institutionalizing Child Survival, Arlington, USAUSA

USAID MANDATEUSAID MANDATE: Find innovative ways to : Find innovative ways to meet the needs of poor Nigerian children in meet the needs of poor Nigerian children in urban communities of Lagosurban communities of Lagos

Core ProcessesCore Processes Nigeria was decertified as a result of military perpetuation by the Nigeria was decertified as a result of military perpetuation by the

American Congress in mid 1990American Congress in mid 1990 UPSI – Urban Private Sector Inventory of CBOs and HFs in late 1994 UPSI – Urban Private Sector Inventory of CBOs and HFs in late 1994

(in 13 communities, 6 selected) in 1995(in 13 communities, 6 selected) in 1995 Selected communities where CPH were formed: Ajegunle, Mushin, Selected communities where CPH were formed: Ajegunle, Mushin,

Surulere, Makoko, Amukoko and Lagos IslandSurulere, Makoko, Amukoko and Lagos Island Community Fora/meetings: 2 meetings held in each cluster area Community Fora/meetings: 2 meetings held in each cluster area

(concept of coalition for improved child care introduced for debate (concept of coalition for improved child care introduced for debate and acceptance as alternative to increasing childhood morbidity and and acceptance as alternative to increasing childhood morbidity and mortality)mortality)

Formation of 6 CPH by interested partners (by end 1995) and Formation of 6 CPH by interested partners (by end 1995) and development of MOU (structure, leadership and responsibilities, development of MOU (structure, leadership and responsibilities, reduced cost of treatment/CBO default prevention/management reduced cost of treatment/CBO default prevention/management arrangement)arrangement)

Constitution developmentConstitution development CPH NGO Community-based Registration by CAC (6 CPH)CPH NGO Community-based Registration by CAC (6 CPH) Setting up of 6 CPH Secretariat. Documentation by 1997Setting up of 6 CPH Secretariat. Documentation by 1997 (provided (provided

lessons for Kano, Abia States) – a total of 16 CPH set uplessons for Kano, Abia States) – a total of 16 CPH set up

ManagementManagement

Needs assessment/Work plan development sessionsNeeds assessment/Work plan development sessions Training in Democracy and GovernanceTraining in Democracy and Governance Establishment of women’s empowerment Establishment of women’s empowerment

committeescommittees Establishment of youth wingsEstablishment of youth wings Establishment of savings and loans cooperativesEstablishment of savings and loans cooperatives Establishment of micro-credit schemeEstablishment of micro-credit scheme Design, printing of letterheads, brochure for identityDesign, printing of letterheads, brochure for identity Promotion of inter CPH collaboration/competitionPromotion of inter CPH collaboration/competition Capacity building on M & E skillsCapacity building on M & E skills

Logistical SupportLogistical Support

Provision of megaphones for awareness campaignsProvision of megaphones for awareness campaigns Provision of cold chain equipment and materials for Provision of cold chain equipment and materials for

immunizationimmunization Provision of environmental sanitation tools for Provision of environmental sanitation tools for

sanitation activitiessanitation activities Provision of start-up stock of office suppliesProvision of start-up stock of office supplies Gifts of used vehicles, office furniture and Gifts of used vehicles, office furniture and

computers by USAID (some were sold – e.g. Surulere computers by USAID (some were sold – e.g. Surulere – ($3,100)– ($3,100)

Registration of partners (HF & CBOs)Registration of partners (HF & CBOs) Raffle ticket & appeal fundsRaffle ticket & appeal funds Support for external audit of CPH accountsSupport for external audit of CPH accounts

TrainingTraining

Needs Assessment for carrying out child and Needs Assessment for carrying out child and community health programscommunity health programs

Operationalizing the cost of reduced health Operationalizing the cost of reduced health care cost on credit/building CBO Capacity to care cost on credit/building CBO Capacity to support failed individualssupport failed individuals

Technical training on childhood target Technical training on childhood target diseases: Malaria, Diarrhea & 6 immunizable diseases: Malaria, Diarrhea & 6 immunizable childhood diseaseschildhood diseases

Training of TBAsTraining of TBAs H/Education materials developmentH/Education materials development

MembershipMembership

In Lagos: 700 partners identified (395 CBOs & In Lagos: 700 partners identified (395 CBOs & 330 HFs of which 279 interviews were completed, 330 HFs of which 279 interviews were completed, only 90 out of CBOs reported involvement in any only 90 out of CBOs reported involvement in any health activities-71 specifically mentioned health activities-71 specifically mentioned immunization)immunization)

Community fora were organized around potential Community fora were organized around potential HF and CBOs that were likely to form dyadic HF and CBOs that were likely to form dyadic partnership- minimum of one HF and one CBO partnership- minimum of one HF and one CBO within a larger CPHwithin a larger CPH

Community fora was held in (community halls, HF Community fora was held in (community halls, HF and clinics, schools, religious buildings)and clinics, schools, religious buildings)

CPH Board FormationCPH Board Formation Formation of fund raising committeeFormation of fund raising committee Formation of finance & Budget committee etcFormation of finance & Budget committee etc

Characteristics of CPHCharacteristics of CPH

Mushin CPHMushin CPH Eligible groups Eligible groups - 40- 40 Reached/ContactedReached/Contacted - 33- 33 Attended ForaAttended Fora - 23- 23 Joined CPHJoined CPH - 8- 8 Joined (not identified)Joined (not identified) - 6- 6

ENTIRE CPHENTIRE CPH 6 CPH initially comprised of 72 groups (80%) CBOs6 CPH initially comprised of 72 groups (80%) CBOs Drop out – 2 CBOs, relocation of a dyad AJCPH toDrop out – 2 CBOs, relocation of a dyad AJCPH to

AMCPHAMCPH 2 years later, membership increased to 137 groups2 years later, membership increased to 137 groups

NetworkingNetworking Inter-CPH meetings, programs, and joint programsInter-CPH meetings, programs, and joint programs LGA (supplied trucks for refuse collection)LGA (supplied trucks for refuse collection) State MOH (annual immunization campaign) and Women Affairs State MOH (annual immunization campaign) and Women Affairs

(women empowerment-Mock Democracy Parliament Program)(women empowerment-Mock Democracy Parliament Program) Local schoolsLocal schools International donors/AgenciesInternational donors/Agencies UNICEF (All registered, collected 36,000 ORS for cholera UNICEF (All registered, collected 36,000 ORS for cholera

emergency response)emergency response) Ability to response to emergency situations in all the Ability to response to emergency situations in all the

communities by 1997communities by 1997 Full program implementation by 1997Full program implementation by 1997 Youth networking on week-long HIV/AIDS campaign, and “I am Youth networking on week-long HIV/AIDS campaign, and “I am

pregnant” - AJCPHpregnant” - AJCPH

AccomplishmentsAccomplishments Increased immunizationIncreased immunization Cleaner environmentCleaner environment Making health care accessible and affordable to membersMaking health care accessible and affordable to members Community coalition was extended to address other issuesCommunity coalition was extended to address other issues e.g. elections, politics, education etce.g. elections, politics, education etc CPH model was an innovative way to involve the private CPH model was an innovative way to involve the private

sector in reaching the poor with quality health and sector in reaching the poor with quality health and preventive servicespreventive services

CPH model actually dispelled rumors that community health CPH model actually dispelled rumors that community health coalitions are impossible in urban areascoalitions are impossible in urban areas

CPH was replicated in Kano and Abia StatesCPH was replicated in Kano and Abia States Lessons learned from CPH was transferred to the design of Lessons learned from CPH was transferred to the design of

another model (CAPA) that works with government and the another model (CAPA) that works with government and the people opon transition to democracypeople opon transition to democracy

Sustainability IssuesSustainability Issues

Ability to:Ability to: Govern themselves including managing of Govern themselves including managing of

resources and conflict resolutionsresources and conflict resolutions Generate resources to maintain programs Generate resources to maintain programs

on a continuous basison a continuous basis Plan and implement programs Plan and implement programs

independentlyindependently Link with other development agencies and Link with other development agencies and

donorsdonors

Thank youThank you

ReferencesReferences

William R. Brieger et al: William R. Brieger et al: Community Partners Community Partners for Health: Urban Health Coalitions in Lagos, for Health: Urban Health Coalitions in Lagos, NigeriaNigeria International Quarterly of Community International Quarterly of Community Health EducationHealth Education2000-01;20(1):59-812000-01;20(1):59-81

Silimperi DR et al: Silimperi DR et al: Lagos Community Lagos Community Partners for Health: Innovative Private Sector Partners for Health: Innovative Private Sector Partnership Promote Child SurvivalPartnership Promote Child Survival. . Arlington BASICS (USAID), 1997Arlington BASICS (USAID), 1997