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The Adamawa Primary Health Care System Dr Abdullahi Dauda Belel Chairman, Adamawa SPHCDA, Nigeria 23 rd April 2014 1.

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Presentation on theme: "The Adamawa Primary Health Care System Dr Abdullahi Dauda Belel Chairman, Adamawa SPHCDA, Nigeria 23 rd April 2014 1."— Presentation transcript:

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

2 Presentation Outline  Background Information  PBF Introduction  Progress in implementation  Results  What’s Responsible? 2

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 3

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 Source: Service Delivery Indicator (SDI) Survey, 2013

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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 6

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 7

8 PBF Introduction 8 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 9

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 10

11 Minimum Package of Activities 11

12 Complimentary Package of Activities 12

13 Results

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15 Increase coverage across the 3 PBF States Adamawa NasarawaOndo 15 Institutional Delivery Assumption: Estimated crude birth rate (per 1000 pop): Adamawa (51), Nasarawa (38), Ondo (32)

16 Adamawa Nasarawa Ondo 16 Quality Score (%) Quality scores are converging at high level but still have variations across states

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

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 18

19 Thank you PLEASE VISIT & 19


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