Title of Project

Organizational, Leadership and Management Strengthening Support to the NPHCDA and SPHCDA/Bs.

Background

The ‘Bringing Primary Health Care Under One Roof’ (PHCUOR) initiative is part of a Government reform designed to improve co-ordination for Primary Health Care service delivery. The PHCUOR framework provides guidance on how to align activities with policies and regulations, under specific thematic domains to be overseen by one management body, funded from one financial system and the system’s performance monitored under one monitoring and evaluation (M&E) plan. It takes into cognizance the diverse dynamics that exist between and within different states as well as the challenges that emerge attempting to impose a single model, allowing domestication as necessary.

The dissemination program/workshop was conducted to sensitize State Primary Health Care Development Agency/Board Executives to the current developmental projects and implementation solutions that have been developed within the PHCUOR space.

The objectives of the dissemination include;

  1. To introduce initiatives developed by Preston Healthcare Consulting (e-Hub and RDT) to enhance the implementation of the integrated PHC Governance Agenda.
  2. To share with Executive Secretaries of State PHC Boards/Agencies, the PHC Development strategy for the country.
  3. To elicit challenges and barriers that Agencies and Boards are experiencing in PHCUOR implementation, through an interactive session.
  4. To share and learn from the lessons learnt and best practices of other States.
  5. 5. To identify key advocacy issues for follow-up by the advocacy partner groups (Nigerian Governors Forum (NGF), Mamaye and Network for Health Equity and Development - NHED).

Date of Meeting

15th – 16th, June, 2017

Location

Fountain Hall, Rockview Royale Hotel, 196 Ademola Adetokunbo Crescent, Wuse 2, Abuja, Nigeria.

Summary of Activities - Day 1 (15th June, 2017).

The meeting was well attended. Participants included the Executive Director (ED) of NPHCDA, Dr Faisal Shuaib, Minister of Health (represented by his Senior Technical Adviser, Dr. Yewande Adeshina), the State Primary Health Care Development Agencies/Boards (SPHCDA/Bs) Executive Secretaries (ESs) of the 36 states and FCT, the Director General, Nigeria Governors’ Forum (NGF), the CEO Preston HC as well as representatives from Preston HC, Mamaye, MNCH2, NHED, BMGF, HSDF, JPHIEGO, NURHI, Directors from NPHCDA and other stakeholders. The meeting began with individual prayers and was chaired by the ED, NPHCDA who welcomed participants and thereafter invited Dr. Yewande, representing the Minister of Health to give the opening remarks. In attendance were about 130 people.

Primary Health Care (PHC) Visions in Nigeria

The Vision for Primary Health Care in Nigeria was presented by the ED of NPHCDA, Dr. Faisal Shuaib. In the ED’s brief, he lamented that every day 3000 girls under 5, die in Nigeria, which does not make the headlines because it happens mostly to the poor. He queried the logic of the usual 10 year target setting and emphasized the need to change it urgently, “it is now an emergency”. He encouraged participants not to relent and told a story about an encounter he had with the parents of a child that was saved from polio in Nasarawa during a recent immunization campaign. “To those parents, it was a gift of life”. He promised positive and impactful changes in NPHCDA. His Technical Adviser, Dr Chima Onoka gave the full presentation on the overview of the NPHCDA’s Vision, the PHC revitalization strategy and how they will be achieved.

PHCUOR and Its Nine (9) Pillars by Network for Health Equity and Development (NHED)

Dr. Sokpo (Country Director, NHED) acknowledged that PHC System is bedeviled with several challenges resulting in its inability to achieve desired health outcomes, listing some of the responsible factors. He pointed out the importance of these factors and assured listeners that PHCUOR was capable of remedying most of the challenges. He explained that the framework is at par with international best practices, based on the World Health Organization’s guidelines for Health Systems Strengthening.

Nigeria Governors’ Forum Presentation (NGF)

The NGF presentation was delivered by Mrs. Chinekwu Oreh. She started by giving insight into the setup of the organization. The NGF she reported, is made up of all 36 Governors, regardless of political party, with a secretariat as the intermediary. Partners also provide technical and administrative support to the forum. Under primary health care, the NGF listed its achievements with regards to the PHCUOR reform, which have been largely successful.

Preston Healthcare Consulting Presentation

Dr. Nkemdilim Ene, CEO of Preston Healthcare Consulting presented an overview of the support Preston has been opportuned to provide. She intimated participants on progress made to date within NPHCDA to develop a web-based interface where people around the world can access information regarding primary health care governance for every state. Also, Rapid Diagnostic Tools have been developed to self-assess their performance. She explained that this would provide states with guidance for instituting the reform by themselves, using an electronic, easy-to-administer, quick, color coded, excel based form, without the need for external technical assistance. She insisted there was a need to understand why the states were where they were in implementing this reform as a means to identifying the solutions needed for them to fix the existing gaps.

She described the several methodologies that were used in the state-level organizational capacity assessments including the “backcasting” and “fit for purpose” approaches. She emphasized the need for synchronization between Minimum Service Package, Human Resources and Budgeting. She outlined the general findings of these assessments, without making reference to specific states where they were conducted.

Mamaye’s Presentation

Mrs. Fola Rachael Adewusi presented on behalf of the Country Director of Mamaye (E4A), Dr Tunde Segun. She intimated the group on what Mamaye stands for and its commitment to saving maternal and newborn lives. She explained that Mamaye was contracted by PAI for PHC advocacy in Nigeria. The project was titled “Strengthening Primary Health Care Policy and Resources”. This was conceptualized with the intention of making countries strive towards good quality primary health care. She complained that PHC is generally underfunded. According to her, these commitments from PAI and other donors will expose Nigeria’s Primary Health Care system to international financial and advocacy interventions. Mamaye is to facilitate the establishment and maintenance of CSO coalitions along with some other partners. She informed participants that In order to strengthen the SPHCDAs, Mamaye was of the opinion that PHCUOR framework remained the right reference point for intended advocacy and with the use of the Scorecard, areas needing attention in SPHCDA could be identified, agreed upon and the process documented. She concluded by saying, Mamaye was currently working in 9 states (Cross Rivers, Kano, Abia, Nasarawa, Niger, Katsina, Bauchi, Gombe and Lagos).

MNCH2 Supports for PHCUOR

The presentation was made by the Deputy National Team Leader (Technical), Abdul Samad Saliu. He listed the ongoing programs, key support areas and key challenges facing MNCH2. The support areas include governance as well as development of organizational capacity for LGA PHC Department/LGHA and SPHCDA/B. He stated that MNCH2 assesses the capacities of the organizations to deliver on their mandate; identifies capacity gaps; guides development and implementation of capacity development to address the gaps in a targeted way under human resource for health, service delivery and resource mobilization among others.

At the end of the presentations, the Executive Secretaries were divided into groups for a breakout session which was to be finalised with feedback presentations from each group. However, the feedback session could not hold due to time constraint, and as a result, was shifted to the second day.

Day 2 (16th June, 2017)

Prayer was said individually, to commence the program. The Technical Adviser to the ED NPHCDA, Dr. Chima Onoka gave a recap of Day 1 after which the breakout groups made their feedback presentations. In summary, the challenges and recommendations highlighted by the combined group were as follows:

  1. Absence of clear guidelines on the implementation of PHCUOR and Funding formulas for SPHCDAs.
  2. Nomenclature of the Board Titles and Positions (What name should be adopted? What is the meaning?).
  3. Challenges in transfer of LGA staff to the control of the SPHCDA Board.
  4. Saving One Million Lives Fund (SOML) domiciliation.
  5. Absence of or inadequate Office Accommodation for some of the SPHCDAs.
  6. Absence of standardized Operational guidelines.
  7. The court case brought against the Anambra SPHCDA by Local Government Chairmen.
  8. Absence of governing boards in some states.

The ED responded to the complaints and encouraged continuous commitment, assiduousness and togetherness. He promised to ameliorate the issues that were raised concerning NPHCDA and that by 18th September 2017, the necessary guidelines needed would have been made available through consultation with the SPHCDAs and Volunteers with recommendations. Some participants also suggested that good practices should be shared so that state PHC leaders would learn from one another.

Presentations on RDTs and e-Hub

PRESTON presented two electronic based solutions, the Rapid Diagnostic Tools and the e-Hub. RDTs will help in diagnosis, prioritization and inform decision making. The set of tools, which cover the 9 domains of PHCUOR, are both cost and time effective. Since it is self-administered, it is also convenient. The Lagos SPHCDA represented by the Director of Nursing Services, Mrs Odukoya, was invited to narrate their experience with the RTDs, during the pilot. She spoke at length recounting their experience and happily informed the audience how useful the tool was to them in revealing where there were performance gaps as well as where they are doing well. The presentation was followed by a practical demonstration session which was handled by Mr. Nonso Onwudinjo. Participants were practically guided step by step on how to access the RDTs by visiting the e-hub website using internet or by downloading the PHCUOR application from Google play store to their devices for offline use. He highlighted that every state had its own profile where it can share information with other states. There is a “Super-Admin” at the NPHCDA Headquarters that will be in control of the platform. Mr Onwudinjo appreciated the NPHCDA ICT team led by Winifred Onwuka for their leadership in the development of the platform.

MNCH2 - Solutions that work

MNCH2 highlighted the strategies being employed to contribute to PHCUOR some of which include; the renovation of Health Facilities (461 HFs out of 954 earmarked), establishment of a resource - base of Master Trainers and Mentors (MTMs) across supported States (16 per States), collaboration with SOGON for continuous capacity building, mentoring and coaching of PHC service providers, institutionalization of an integrated delivery model of a package of services (BEmONC, RI, IMCI, HTSP), institutionalization of Sustainable Drug Supply Systems (SDSS) integrating Drug Revolving Fund and free drug supply system to ensure continuous availability of life saving commodities in PHCs, supply of basic equipment, essential Drugs and medical consumables (worth over NGN 3 billion), among others.

Mamaye Advocacy Project Strategies that work

Mamaye presented the various strategies being used to strengthen the advocacy pillars of the PHCUOR. The presenter Mrs Fola Rachael Adewusi narrated how PAI consulted Mamaye on a project titled ‘All Ships Rise: Strengthening Primary Health Care Policy and Resources’. She explained the various aspects of primary health care to be advocated for, emphasizing maternal and newborn health. The goals of Mamaye in the PHCUOR advocacy is to act as lead CSO convening agent of a coalition of in-country partners working collaboratively to advocate for PHC in Nigeria and actively participate in the global advocacy working group convened by PAI.

Group Exercise

Dr Ene co-ordinated the Group Work Session. The ESs were grouped into their respective geo-political zones. The NPHCDA Zonal Directors facilitated discussions in each group. Each group was asked to download the RDTs through the e-hub and fill out the office setup domain for a chosen state from within their group. On average it took less than 30 mins for the groups to complete this exercise. There were no issues with the actual practical use of the RDTs. The participants were very excited at the usefulness and usability of the tool. They all proclaimed the tools were easy to use and that they enjoyed the exercise.

Conclusion

Dr Oladimeji, Director Primary Health Care System Development (PHCSD), thanked participants for taking out time to attend this event and for playing a contributory role during the process. He also acknowledged Preston HC and other partners for funding and organizing the event. He concluded by urging the ESs to use the Solutions that have been presented today as tools to better improve the implementation of PHCUOR and ultimately service delivery.

Challenges

  • The one day event that was planned for the 22nd had to be moved forward to allow for a joint 2-day event with NGF on the 15th and 16th. It would have been unfair to the invitees to have to travel to attend the meeting on the 15th in Abuja and then to be asked to do it again one week later as well. This change also led to more ESs than the original number planned for, being invited to stay over. The two day event was co-funded by Preston and NGF.
  • Delayed commencement of meeting by about 45 minutes on Day 1 and the push back of the Day 1 feedback session to Day 2.
  • Over attendance of participants above the planned estimates led to a few persons not getting food on the first day sponsored by NGF. This gap was however filled the second day which was sponsored by Preston.

Recommendations

Subsequently, NPHCDA and partners (such as Preston) should have stand alone dissemination exercises in order to allow for better assimilation and a deeper understanding of the solutions being promoted.

For coverage of the event by the media see the link below: https://www.thisdaylive.com/index.php/2017/06/22/healthcare-funding-partners-are-no-replacement-for-govt-says-ene/

Next Steps

  • NPHCDA to lead the advocacy effort for PHCUOR (Top – Bottom approach)
  • NPHCDA to use the e-hub to bridge the information gap with states. Access to tools, manuals, survey findings, guidelines and reports.
  • SPHCDAs to use the e-hub to exchange lessons learnt, latest news, challenges, etc with other states for peer learning.
  • NPHCDA should promote the use of the RDTs at state level to facilitate evidence based support to states.
  • Review of SPHCDA/Bs in Northern Nigeria: NPHCDA and Partners continue supporting State SPHCDA/Bs to make use of the agreed prioritized action plans to tackle identified barriers in order to close existing capacity and functionality gaps.