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The Adamawa Primary Health Care System

Dr Abdullahi Dauda Belel

Chairman, Adamawa SPHCDA, Nigeria

23rd April 2014

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Presentation Outline

Background Information

PBF Introduction

Progress in implementation

Results

What’s Responsible?

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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

Source: Service Delivery Indicator (SDI) Survey, 2013

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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

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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

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Demsa

Fuf ore

Gany e

Girei

Gombi

Guy uk

Hong

Jada

Lamurde

Madagali

Maiha

May obelwa

Michika

Mubi North

Mubi South

Numan

Shelleng

Song

Toungo

Yola North

Yola South

PBF Introduction

PBF

PBF scale up

DFF

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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

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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

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Minimum Package of Activities

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Complimentary Package of Activities

Results

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Increase coverage across the 3 PBF States

Adamawa Nasarawa OndoInstitutional Delivery

12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 120%

10%

20%

30%

40%

50%

60%

Assumption: Estimated crude birth rate (per 1000 pop): Adamawa (51), Nasarawa (38), Ondo (32)

Adamawa Nasarawa Ondo

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Qu

ality

Score

(%

)

Q4 '11

Q1 '12

Q2 '12

Q3 '12

Q4 '12

Q1 '13

Q2 '13

Q3 '13

Q4 '13

- 10 20 30 40 50 60 70 80 90

100

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51

66 64

45

57 66 67 67

21

65

81 84 83 83 87 86 85

41 52

69 67 70 65 66 68

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

Adamawa Nasarawa Ondo

From (2011) To (2013)

Significant improvement has been observed in many areas, with a few areas of consistently low scores

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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

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Thank you

PLEASE VISIT US @:

http://nphcda.thenewtechs.com&

http://adsphcda.org.ng