2012 Mid Term Review of FCT Strategic Health Development Plans
By
Dr Saka Mohammed Jimoh (Consultant)
Josphine Ugbah (FMoH Statitical Officer HPRS
June Eruba (FMoH Programme Officer Family Health)
Basheeru Nurudeen (NPPHCDA)
July 2013
1
ACKNOWLEDGEMENT
The MTR Review Team appreciates the leadership demonstrated by the
Honourable Secretary Health Service, The Director of Planning Research and
Statistics Dr Kawu, The General Manager DR A.M. MAI Hospital Management
Board and the Top Management Committee of the FCT which provided support to
the planning and execution of the MTR is greatly acknowledged and appreciated.
Specific thanks to Honorable Ministers of FCT, Executive Secretary of PHCDB,
Chief Medical Director of Gwagawalada Teaching Hospital, Directors and other
senior staff and in-charge of General Hospital and primary health care facilities
their active role participation from the orientation till the end of the review is well
appreciated.
Also, thanks go to all other stakeholders for their contributions to the success of
this effort, HOD Health, in charge of health facilities, and communities’ members.
Development Partners namely; UNICEF, WHO, MSH, and the World Bank. These
agencies not only participated actively and respond to short call during review
process.
2
TABLE OF CONTENTS
Pages
Cover Page ………………………………………………………………………………………2
Table of Content…………………………………………………………………………………3
Acknowledgment………………………………………………………………………………..ii
Acronyms…………………………..………………………………………………………….5-8
Executive Summary …………………………………………………………………………9-11
1.0
1.1
Introduction ………………………………………………………………………..12-14
objectives …………………………………………………………………………..15-16
1.2
Situation Analysis and health Systems …..………………………………………16-19
1.3
Methodology ………………………………………………………………............20-23
2.0
Results and Findings………………………………………………………………24-25
2.1 Process of roll out and Implementation of the FCT SHDP ……………………24-25
2.2 Progress on Performance Domain ………………………………………………..262.2.1 Reduction in Child Mortality ……………………………………………………26-27
2.2.2 Reduction in Maternal Mortality ………………………………………………….27-28
2.2.3 Reduction in the Transmission of HIV/AIDS, TB & Malaria ……………………..28- 31
2.3
Progress on Systems Domain Facilities…………………………………………
2.3.1
Governance ………………………………………………………………………35-36
2.3.2 Service Delivery ……………………………………………………………………36
2.3.3 Human Resources for Health……………………………………………………..36-38
2.3.4. Health Financing …………………………………………………………………..39-40
2.3.5. Health Management Information Systems ………………………………………41
2.3.6. Community Ownership and Participation……………………………………… 42
2.3.7. Partnership for Health…………………………………………………………….42-43
2.3.8. Research for Health ……………………………………………………………….44
3..0 Challenges and Opportunities ……………………………………………………..48-50
3
3.1. Challenges………………………………………………………………………………48-49
3.2. Opportunities…………………………………………………………………………..50
4. 0 Way Forward and Priorities for Next year…………………………………………51-53
4.1. Way Forward …………………………………………………………………………51-52
4.2 Priorities for Next Year ………………………………………………………………52-53
References …………………………………………………………………………………53-54
5.0 Annexes …………………………………………………………………………………55-60
Annex 1 List of attendance at the orientation meeting…………………………………55--56
Annex II List of Field Team for ToT ……………………………….…………………..57-58
Annex III List of attendance at the validation meetings ……………………………58-60
Annex 5. List of Joint Annual Review Members ………………………………………….35
4
LIST OF ACRONYMS
AC
Area Council
AIDS
Acquired Immune Deficiency Syndromes
AMAC
Abuja Municipal Area Council
ANC
Ante natal Care
ATM
Aids Tuberculosis and Malaria
CBHI
Community Based Health Insurance Scheme
CHEW
Community Health Extension Workers
CHEW:
Comm. Health Extension Workers
CHEWs
Community Health Extension Workers
CHO
Community Health Officer
CHO:
Comm Health Officer
CPR
Contraceptive Prevalence Rate
CPR
Contraceptive Prevalence Rate
DFA
Director of Finance and Administration
DPA
Department Agency and Programe
DPHC
Directorate of Primary Health Care
DPRS
Directorate of Planning, Research and Statistics
DPRS
Director of Planning Research and Statistics
5
DPS
Directorate of Pharmaceutical Services
ETE
End-Term Evaluation.
FCT
Federal Capital Territory
FMOH
Federal Ministry of Health
FP
Family Planning
HCT:
HIV Counseling & Testing
HIV
Human Immune Virus
HMB
Hospitals Management Board
HMIS
Health Management Information Systems
HRH
Human Resource for Health
HSDP-II
Health Systems Development Project-II
HSR:
Health Sector Reform
IDSR
Integrated Disease Surveillance Research
ITNs:
Insecticide Treated Nets
JAR
Joint Annual Review
JAR
Joint Annual Reviews
M&E
Monitoring and Evaluation
MCH
Maternal and Child Health
MDCAN
Medical and Dental council of Nigeria
6
MDCN
Medical and Dental Council of Nigeria
MDG
Millennium Development Goal
MNCH
Maternal Neonatal Child Health
MSH
Management Science for Health
MSS
Midwife Service Scheme
MTCT
Mother to Child Transmission
MTR
Mid-Term Review
MTSS
Mid-Term Sector Strategy
NCH
National Council on Health
NDHS
National Demography Health Survey
NGOs
Non-Governmental Organizations
NHMIS
National Health Management Information Systems
NSHDP
National Strategic Health Development Plan
NSHDP
National Strategic Health Development Plan
NTBLCP
National Tuberculosis and Leprosy Control Programme
PHC
Primary Health Care
PHCDB
Primary Health Care Development Board
PMTCT
Prevention of Mother to Child Transmission
RMRT
Routine Malaria Report Tool
7
RN/RM:
Registered Nurse /Midwives
SHC
Secondary Health Care
SMOH
State Ministries of Health
SSHDP
State Strategic Health Development Plan
SURE-P
Subsidy Reinvestment Programme
TB
Tuberculosis
TBL:
Tuberculosis and Leprosy
TMC
Top Management Committee
TWG
Technical Working Group
UNICEF
United Nation Children Fund
WB:
World Bank.
WDC
Ward Development Committee
WHO
World health Organization
8
Executive Summary
The FCT being the seat of the government of an emerging national economy
experiences an influx of people which boosts the annual population growth rate to
9.3%, a level considerably above the national level of 3.2%. With an official 1.4
million population (1,406,239 (673,067 females; 733,172 males), children under 5
years make up 20% and Women of child bearing age 26.7 % of the total population,
the 2006 National Population and Housing Census indicated that about 56.4% of
the population aged 6 years and above were literate with 77% of women and 89%
men being literate.
The objectives of the Mid -Term Review (MTR) are to explore, the outstanding
issues relating to the processes of development and implementation of the FCT
SHDP. Review and assess for documentation, the extent to which the milestones
and targets set for the FCT SHDP and its component plans in their respective
results matrices are achieved. Document constraints and/or challenges encountered
and solutions provided, draw best lessons learned and experiences gained in
implementing FCT SHDP, and forward recommendations to improve future
management and implementation of activities to attain the FCT SHDP goals.
In achieving the objectives three prong methods was adopted for the review this
include documentary desk review, Interviews of stakeholders and field Visits. This
specifically focused on indicators related to the Systems-Process Domain of the
NSHDP: Leadership and Governance, Service Delivery, Human Resources for
Health (HRH), Health Financing, NHMIS, Community Participation, Partnerships
for Health Development and Research.
The findings showed that the FCT is on course in reduction of morbidity and
mortality rates due to communicable and Non communicable diseases to the barest
9
minimum. SHDP was used as a guiding document in development of annual
operation plans, Midterm Sector Strategy (MTSS) and Area council action plans.
FCT produced annual Health Bulletin called health watch, Monthly Newsletter and
Quarterly presentation of key performance indicators (KPI) based on SHDP. At the
time of the review, there are mechanisms in place for FCT council of health.
Although the child mortality rate in the FCT is lower than the national average
rate, more efforts should be made to further bring it down. While under-five
mortality rate (U5MR) in the FCT stood at 135/1000 in 2009, 155/1000 in 2010
(FCT Health Bulletin 2010), rose to 179/1000 in 2011 higher than the national
figure is 172/1000(MICS 2011) and reduced to 157/1000 in 2012. FCT Maternal
Mortality Ratio (MMR) of 302/100,000 is lower than the National Rate of
545/100,000(MICS 2011) these figures are still unacceptably high and efforts
should be made to bring them down. However, the figure is higher than 2009 and
2011 figures of 107/100,000 and 281/100,000 respectively. Though is lower than
2011 data of 378/1000. Percentage of annual non-personnel budget executed by
FCT was 41.96% in 2009 and increase to 53.1% in 2010, fell to 40.3% and 44.0%
in 2011and 2012 respectively (FCT Health Bulletin, 2011). FCT percentage
allocation of Health Budget were; 5.06% in 2006, 6.91% in 2007, 9.06% in 2008,
9.62% in 2009 and 5.13% in 2010, 5.40% in 2011 and 4.40% in 2012. Although
there was a noticeable rise in the percentage allocation of Health Budget from 2006
to 2009, the sudden reverse in 2010 with drastic fall in 2012 was a real setback to
the Health sector. No reason could be adduced for this but may be due to the
presumption that the FCT being the Federal Capital must be enjoying other forms
of Health Financing from some major Health Partners as well as the MDG funds. If
it’s true, this development will not augur well for the Health delivery of the FCT
10
since the partners may decide to withdraw their services from the country at any
time.
It is however worth mentioning that not all the budgeted activities are provided for
in the FCT 2013 statutory budget, this means that the Administration received the
assistance of the Development Partners. Percentage of health budget spent on
health research and evaluation at FCT was 0.04% in 2009, 0,025% in 2010, 0,33%
in 2011 and 0.08% in 2012.
Despite, the opportunities the FCT is the heath of the Nation both the FCT
administration and FGN budgeted for development, there are challenges such as
duplication of roles and responsibilities, PHCs facilities are being coordinated by
PHCD, PHC department, and Public Health department all the FCTA. The quality,
quantity and mix of health care workers are poor with a skewed distribution
towards the FCT to the detriment of the six area councils. For example, there are
more Medical Doctors in the services of the FCT Human and Health Services
Secretariat (241) compared to the doctors in the services of all the 6 Area Councils
put together (21). In addition, the shortfalls in the expected number of Health
Professional are almost thrice the number on ground.
It is recommended that more budgeting should be provide for research and
implementation of organization plan.
11
INTRODUCTION
1.1Background
a) The basis for undertaking the MTR
The decade of the 1990s witnessed significant deterioration in Nigeria’s health
status. For example, immunization plummeted from coverage of 57% in 1991 to
42% in 20061 and so did life expectancy from an estimated 52 years to 47 years2.
Since the advent of the Third Republic in 1999 however, the country has been
exploring ways to improve the health status of its population. The first major
national initiative during this period was the Health Sector Reform (HSR) 200320073. That reform achieved a number of successes recorded in the formulation
and/or reviews of national policies and strategies related to the strengthening of the
health system.
However, cognizant that the pace of progress towards the achievement of national
health objectives including the Vision 20:2020 and the Millennium Development
Goals (MDGs) was slow, the Federal Ministry of Health (FMOH), under guidance
from the National Council on Health (NCH) worked with State Ministries of
Health (SMOH), FCT and other stakeholders to produce the National Strategic
Health Development Plan (NSHDP)4.
The Plan was a product of extensive work that saw the commissioning of studies in
10 major related areas; the setting up of a multidisciplinary Technical Working
Group (TWG) that developed the framework5 which states, Federal Capital
1
United Nations Statistics Division, United Nations, New York: The official United Nations Site for the MDG
Indicators
2
National Demographic and Health Survey, 2008
3
Federal Ministry of Health, Abuja, Nigeria: Nigeria, Health Sector Reform (2003-2007)
4
The National Strategic Health Development Plan, Federal Ministry of Health, Abuja, Nigeria, 2010
5
The National Strategic Health Development Plan Framework (2010-2015); June 2009, TWG-NSHDP/Health
Sector Development Team
12
Territory (FCT) and the Federal Ministry of Health used in the development of
their strategic health plans; the hiring, training and deployment of consultants to all
states, FCT and FMOH to facilitate their plan development; and the training of
relevant MOH officials to assist both states and FMOH in the development of their
plans.
In elaborating the framework for NSHDP development, the TWG identified eight
priority areas to improve the Nigerian health system namely: leadership and
governance, service delivery, health financing, human resources for health, health
information system, community participation and ownership, partnerships for
health development and research for health.
For each of these priority areas, the framework details the context, goals, strategic
objectives, and recommended evidence-based and cost-effective interventions
required to deliver improved performance of the health system and health
outcomes for Nigerians. For each of these interventions, there were recommended
indicators, which later formed the basis of the National Results Matrix with 52
indicators, 2011 and 2013 milestones, along with 2015 targets as well as data
sources.
The resulting NSHDP was approved in March 2010 by the 53rd NCH held in
Asaba, Delta State. The National Strategic Health Development Plan is the first of
its kind in the history of Nigeria’s Health Care Delivery System. It serves as the
overarching, all encompassing, reference document for actions by all stakeholders
to ensure transparency, mutual accountability for results in the health sector. It was
developed using a participatory bottom-up approach to ensure ownership by all the
three tiers of government. The component 36 states, 1 FCT and 1 FMOH were
aggregated into the NSHDP.
13
The overarching goal of the NSHDP is to significantly improve the health status of
Nigerians through the development of a strengthened and sustainable health care
delivery system. Because access to quality health care and prevention services are
considered vital for poverty reduction and economic growth, it is the health
sector’s contribution to the overall National Programme of Nigeria’s vision
20:20206 with its emphasis on human capacity development. The Federal Ministry
of Health (FMOH) appreciates that this contribution can best be realized within the
context of a costed NSHDP, which is aimed at providing an overarching
framework for sustained health development in the country. The NSHDP was
therefore developed in accordance with extant national health policies and
legislation, and international declarations and goals to which Nigeria is a signatory,
namely; MDGs, Ouagadougou Declaration on PHC and the Paris Declaration on
Aid Effectiveness.
The NSHDP with its National Results Framework immediately became the subject
of commitment by all state governors and the President of the Federal Republic of
Nigeria at a Presidential Summit on Health to which all concerned committed
themselves in the form of a Presidential Summit Declaration signed by all. The
elaboration of the National Results Framework and the plans propose Joint Annual
Reviews (JAR), a Mid-Term Review (MTR) and an End-Term Evaluation (ETE).
This combined 2012 JAR and 2013 MTR is therefore in conformity with that
proposal.
In accordance with the Plan and the IHP+ Compact, Nigeria had successfully
conducted 2 Joint Annual Reviews for 2010 and 2011 respectively. The reports of
those reviews will form inputs into this JAR/MTR combined.
6
Nigeria Vision 20:2020: The First National Implementation Plan (2010-2013). Vol.II Sectoral Plans and
Programmes; May 2010
14
b. OBJECTIVES OF THE COMBINED JOINT ANNUAL AND MID-TERM
REVIEW
Three years into its six-year life span, it is now proposed to conduct a combined
joint annual review with a mid-term review of NSHDP and its component FCT
SHDPs. The objectives of this review include:
a. Explore the outstanding issues relating to the processes of development and
implementation of the FCT SHDP.
b. Review and assess for documentation, the extent to which the milestones
and targets set for the FCT SHDP and its component plans in their respective
results matrices are achieved;
c. Document constraints and/or challenges encountered and solutions provided,
draw best lessons learned and experiences gained in implementing FCT
SHDP, and forward recommendations to improve future management and
implementation of activities to attain the FCT SHDP goals;
d. Assess the strengths and weaknesses of the health system in the national
policy context (democratization & decentralization, development of
preventive, health promotion services, and other policy focuses) to facilitate
the implementation of the FCT SHDP in the remaining period of the plan;
e. Document the continuum of inputs, process, output, outcome and impact to
show how these have helped or hindered progress in achieving results
targeted in each component plan and especially in the FCT SHDP itself
highlighting the major bottlenecks in this continuum for sharing lessons;
f. Provide conclusion on achievements to determine whether FCT SHDP is on
track, needs any adjustments in implementation or levels of ambition,
including recommendations on useful measures that will help to improve the
implementation of the plans in the remaining time frame;
15
g. Provide recommendations for consideration in the formulation of the
NSHDP2, for issues that require long-term implementation.
h. Provide strategic recommendations on preparation for NSHDP 2 well ahead
of the end of the NSHDP, which should take into account on-going and long
term interventions as well as all recommendations of this Mid Term Review.
1.2Situation Analysis
a)
Socio-economic situation of the FCT
The Federal Capital Territory (FCT) is centrally located and serves as the
administrative seat of the Federal Republic of Nigeria. It is estimated that more
than 70% of its population is rural and this has implications for health service
delivery.
The key economic driver in the FCT is the Government supported by Hospitality
industries, construction companies and the banking industries. A predominantly
civil service dominated environment, there are few notable industries in the
Territory. The major occupations are farming, fishing, trading in iron and wood
works.
The FCT being the seat of the government of an emerging national economy
experiences an influx of people which boosts the annual population growth rate to
9.3%, a level considerably above the national level of 3.2%. With an official 1.4
million population (1,406,239 (673,067 females; 733,172 males), children under 5
years make up 20% and Women of child bearing age 26.7 % of the total population,
the 2006 National Population and Housing Census indicated that about 56.4% of
the population aged 6 years and above were literate with 77% of women and 89%
men being literate. Life expectancy in the FCT, which is put at an average of 52
years for both male and female, is higher than other states of the federation.
16
According to the FEEDS I review report; residents of FCT have improved access
to healthcare and education services. About 60% of FCT residents have access to
clean water defined as borehole and pipe borne water.
b)
The context of the health system in the FCT
Malaria, diarrhea, malnutrition and measles are the leading causes of childhood
mortality and morbidity. Significantly, the FCT records an unacceptable high
number of fatalities of road accidents. In the area of immunization, high rates were
recorded for vaccine preventable diseases thus suggesting that the majority of FCT
children were protected against these diseases.
The bed complement in the Public secondary health care facilities in FCT is about
672. When added to the number at the National Hospital and Gwagwalada
Teaching Hospital, the territory boasts of 2,000 beds at the secondary and tertiary
levels.
17
FCT HEALTH STATUS/INDICATORS FOR 2012
S/NO
INDICES
2012
1
2006 National Census with 9.3% Yearly Projection
FCT Population
2,397,814
2
FCT Under One Population
107,902 (4.5%)
3
FCT Under Five Population
503,541 (21%)
4
FCT Women of Reproduction Age
599,454 (25%)
5
FCT Area Square Kilometer
6
FCT Average Density
8,000 Square Kilometer
300 Persons Per Square Kilometer
7
Doctor Population Ratio
1 : 3,001
8
Doctor Patient Ratio
1 : 1,261
9
Nurse Population Ratio
1 : 1,137
10
Nurse Patient Ratio
1 : 478
11
Pharmacist Population Ratio
1 : 10,705
12
Pharmacist Patient Ratio
1 : 4,497
13
Medical Laboratory Scientist Population Ratio
1 : 11,640
14
Medical Laboratory Scientist Patient Ratio
1 : 4,890
15
Radiographer Population Ratio
1 : 41,342
16
Radiographer Patient Ratio
1 : 17,366
17
Population Per Hospital Bed
1 : 1,315
18
Patient Per Hospital Bed
1 : 36
19
Life Expectancy at birth total (years)
48 yrs
20
Fertility rate, total births per woman
21
Maternal Mortality Rate (MMR)
5
302 maternal deaths per 100,000
live births
22
Infant Mortality Rate (under 2yrs)
75 per 1,000 live birth
23
157 per 1,000 live birth
24
Mortality Rate (under 5yrs)
% of Pregnant Women that Received Ante-natal
Care (ANC)
25
% of New Born with Low Birth Weight
8%
26
Crude Birth Rate
16/1,000
44.5%
18
27
28
Crude Death Rate
1/1,000
Leading Causes of Morbidity and Mortality in FCT
A
Communicable Diseases:
Malaria
77%
Diarrhea
8.3%
HIV/AIDS
7.8%
STIs
Pneumonia
Others
Non Communicable Diseases:
B
Morbidity
4.2%
3%
5.5%
Hypertension
54.4 %
Malnutrition
17.3 %
Diabetes
10.5 %
Asthma
7.9%
Others
9.8 %
NOTE
The above indicators were determined based on statistics from the public health facilities
(HHSS & Area Councils) in FCT, therefore the indices only showed the mirror health
status of the Territory.
19
1.3Methodology
a) Methods: Documentary Review; Interviews of stakeholders and Field Visits
The FCT MTR, Core and Reference committees made up of the Honorable
Secretary, General Manager Hospital Management Board, Executive Secretary
Primary Health Care Development Board (PHCDB), Director of Finance and
Administration (DFA), Director Health Planning Research & Statistics (DPRS).
Technical Working Subcommittee made up of Director of PHC, Director Public
Health, and Epidemiologist, Head Planning and Programs, other units Heads and
all program officers. We also had Research team for field visits and Data Entry
Team. All the committees and Teams were coordinated by Director of Planning
Research and Statistics with responsibility for planning and coordinating the Mid
Term Review process. It is important to note that an MSH an International
nongovernmental organization was part of the review process till the end.
The process for undertaking the joint annual review was divided into phases as
follows:
Phase 1: Preparatory activities for the MTR
This phase recorded the development of the outline and framework for the MTR
process, followed by the development of a comprehensive MTR concept note,
which clarified the objectives and scope, while laying out the MTR
implementation process and timelines. The technical, logistics and financial
resource requirements were equally identified and sourced. In addition,
standardized tools were developed for data collection in line with the concept note,
namely:
1. Tool 1: Desk Review
2. Tool 2: For interview of stakeholders at the FCT/ state level
3. Tool 3: Area Council /LGA interviews and Health Facility spot check
20
4. Tool 4: FMoH, DAP and Teaching Hospital
At the FCT, after the briefing of Honorable Secretary on the outcome of the MTR
work shop and the request from FMoH on the need to support MTR activities.
Following approval for support of MTR activity. Several meetings with FCT MTR
teams, logistics (financial and material) this include memos, letters to all Directors,
head of units, Area councils health department and health facilities (Primary,
Secondary and Tertiary).
Phase 2: Data collection to inform the MTR process
This comprised of a two-prong approach namely the desk review and joint field
assessments, both of which were guided by the four MTR tools developed in Phase
1.
a. Desk Review:
This provided a synthesis of the programme environment and factors supportive
and/or militating against the progress of implementing the SSHDP in 2010. The
desk review was carried out by FCT technical working team for MTR 2012 in
Department of Health Planning Research and Statistics (DPRS), HHSS, HMIS
Units, MDG units, HRH, M&E unit, research unit, PHCDB, Department of Public
Health, Disease surveillance unit, Tuberculosis and Leprosy Unit Nutrition unit,
Finance and Administration (Budget unit,), Disease Control unit, NPI, Nursing
unit, water and sanitation, Child & Adolescent health and other MTR Committees.
Sources of secondary data and information that informed the desk review process
included the FCT
SHDPs, FCT Operation Plans, key performance indicator,
FCT/Area Council Operational Plans, routine FCT HMIS data, FCT IDSR report,
FCT Health Watch (Health Bulletin) 2010-2011 edition, FCT Budget Documents.
FCT 2010 Health Statistical Bulletin, FCT SHDP 2010-2015, FCT Health Profile
21
2010, 2011 and 2012, FCT 2010 Malaria Indicator Survey and FCT call center
Newsletter Vol.1/Number 2/Feb. 2013 among other documents reviewed. In
addition, guided by a structured format and tools, Units and Department submitted
individual progress findings on the implementation of SHDPs, which served as
additional resource materials.
Desk review was carried with the aid of MTR Tool 1 which covers the eight
priority areas of the NSHDP with a focus on systems and performance and has
more than 50 specific items listed. See the references. Desk review started from
22nd of July to 2nd of August 2013 and was greatly facilitated by DPRS FCT (Dr
Kawu), FCT SHDP focal officer (Pharm Samson), FCT SHDP MTR Team, HMIS
Desk Officer, and all the units and Disease specific programme officers. We had
orientation for units head and programe officers.
Annex 1 shows the list of
participants at the orientation.
b. Stakeholder interview
Stakeholder interview involved interview with key people in the FCT, PHCDB,
Hospital management and Area council, also include HoDs Health, head of health
facilities, and in charge of primary health. The aim was to listen to key players in
the state health sector so as to understand the major issues that positively or
negatively affect health achievement. MTR tools 2 and 3 were used for the
interview. Annex ii shows the list of people interviewed.
c. Joint Field Assessment Visits:
Field visit assessment took place between 30th July to 5th of August. Research
(field ) team were trained on 29th July, 2013. The aim of the training was to
familiarize the field team with the MTR tools. Four area councils were randomly
selected, Abuja Municipal Area council (AMAC), Gwagbalada, Kuje and Bwari.
22
A total of 14 health facilities (2 Tertiary HFs, 3 Secondary, 9 PHCs) were selected
(See annex III list of research assistants for field visits and Annex IV for health
facilities visited.). The field teams for assessment visits were grouped into four to
visit each of the selected Area Councils and health facilities.
Data collected, collated clean and enter into excel sheets provided by FMoH
minimal analysis done and preliminary finding was presented at the validation
meeting attended by FCT team and partners. See list of Attendees.
Table 1;-Health Facilities
Area Council
AMAC
10 HC FACILITY
Lugbe PHC
20 0HC FACILITY
Maitam District
Hospital
30HC FACILITY
National Hospital Abuja
Piwoyi PHC
Dutse Gariki PHC
Bwari
Dutse Makaranta PHC
Bwari General Hospital
Deide PHC
Dutse Alhaji
Gwagaladal
Kuje
Gwagalada Teaching
Hospital
Pegyi PHC
Kuje General Hospital
Kuchiako PHC
Kiyi PHC
23
c. FINDINGS
2.1Process of roll out and implementation of the FCT SHDP
Mechanisms put in place at the FCT level for implementing, monitoring and
evaluating the SHDP
There is in existence FCT Strategic Health Development Plan 2010-2015 which
has goals and strategic objectives keyed to the NSHDP. The priority areas covered
performance and system domains but more detailed and adapted to include other
local health issues. The plan has a 2009 baseline year and cost implication of the
activities over the 6-year period. For monitoring a Results/M&E Matrix for the
plan is developed with goals and 2-year milestones (2011, 2013) to a 2015 target as
in the National Matrix.
For the implementation, monitoring and evaluation of the SHDP, there is core
group made of TMC members of FCT under the Chairmanship of Honorable
Secretary Health and Human Services, References group made of Directors within
the FCT chaired by DPRS, Technical Team made of head of units and programe
officers, and MTR Team coordinated by Pharm Samson. FCT produced annual
Health Bulletin called health watch, Monthly Newsletter produced by FC Territory
Administration Call Center and Quarterly presentation of key performance
indicators based on SHDP. At the time of the review, there are mechanisms in
place for FCT council of health.
24
FCTA: ACSS and HHSS CHAIN OF COMMUNICATION
FCT MINISTER
HON. MINISTER OF STATE
(HMS)
FCT PERM SEC
HON. SECRETARY
(HHSS)
DIRECTOR,
PUBLIC HEALTH
(HHSS)
HON. SECRETARY
(ACSS)
THE EXC./SEC.
FCT-PHCDB
DIRECTOR,
PRIMARY HEALTH CARE
(ACSS)
#2
#1
#3
25
Progress on Performance Domain
a) Current status of the following indicators
b) How do they compare with baseline 2009 figures(were available) and 2015
targets
2.2.1 Reduction in Child Mortality (Child Indices)
Although the Child mortality rate in the FCT is still lower than the national
average rate, more efforts should be made to further bring it down. While underfive mortality rate (U5MR) in the FCT stood at 135/1000 in 2009, 155/1000 in
2010 (FCT Health Bulletin 2010), rose to 179/1000 in 2011 higher than the
national figure is 172/1000(MICS 2011) and reduce to 157/1000 in 2012. There
has been some marked improvement in the various low indices such as, percentage
of breast fed children (14.6% in 2011, 13.6% in 2010 cf 12% in 2009) and measles
immunization rate (96.0% in 2012, 84.6% in 2011, 95.0 in 2010 cf 85.0% in 2009)
among others such as
i.
Proportion of 12-23 months-old children fully immunized increased from
83% in 2009 to 91.0% in 2012
ii.
Percentage of children under 6 months exclusively breastfed increased
progressively by 1.6% from 2009 to 2011 (12% in 2009 and 14.6 in 2011)
iii.
Proportion of 1 year old immunized against measles increased from 85.0%
in 2009 to 96.0% in 2012.
iv.
Unfortunately, two (2) new wild poliovirus cases was detected and
confirmed in 2012 against one detected in 2009
v.
Percentage of children under - 5 with suspected pneumonia, receiving
appropriate treatment from a health provider increased from 74.0% in 2009
to 81.0% in 2012.
26
FCT Immunization Progress Report for 2012
60,000
51,190
50,000
39,644 39,931
40,000
30,441
BCG
30,000
OPV 3
17,461
17,394
14,126
14,028
12,414
10,937
7,677
10,004
7,086
6,478
6,079
6,019
6,667
6,295
4,124
4,045
20,000
10,000
3,0733,4923,721
2,887
DPT 3
Measle
0
Abaji
Amac
Bwari
Gwa/lada
Kuje
Kwali
2.2.2 Reduction in Maternal Mortality
Even though 2012 FCT Maternal Mortality Ratio (MMR) of 302/100,000 is still
lower than the national rate of 545/100,000(MICS 2011) these figures are still
unacceptably high and efforts should be made to bring them down. However, the
figure is higher than 2009 and 2011 figures of 107/100,000 and 281/100,000
respectively. Though is lower than 2011 data of 378/1000.
i.
Unmet need for Family Planning increase from 24% in 2009 to 50.0% in
2012
ii.
Though CPR rate also increase from 10.5% in 2009 to 26% in 2012
iii.
However from the FCT bulletin (health watch) Percentage of pregnant
women making at least 4 ANC visits according to standards increase from
65.0% in 2009 to 69.0% in 2012
27
iv.
Proportion of births attended by skilled health personnel increased from
64.3% to 70.0% in 2012. With numerical figures 19,777 live birth in 2009,
23,020 in 2010 live birth, 29,143live birth and 28,890 live birth
v.
More Health Care Facilities are providing Basic Emergency Obstetric Care
Services, 11.11% in 2010 by 223.51%
in 2012. Of the total of 791 HFs,
The actual number of 88 health facilities in 2010, 182 in 2011 and 186 in
2012. None of the hospitals has less than two functional Ambulances with
skilled personnel to handled BEOC.
2.2.3 Reduction in the Transmission of HIV/AIDS, TB & Malaria
Health service delivery
Major strategic thrusts include; Implementation of FCT Minimum Health Care
Package inclusive of Disease Control Strategies, construction and equipping of
infectious disease hospital, construction and equipping of public health
laboratory, construction and equipping of primary and secondary health
facilities in underserved areas and upgrading of existing medical equipment in
Health facilities in FCT. The sum of 6.0billion naira was expended.
Currently FCT administration has 12 public hospitals in operation spread across
the six area councils, and the hospitals are classified into three main groups:
City Hospitals, they are the ones located in Maitama, Asokoro, and Wuse.
SERBAIAN HOSPIITALS: they are located in Gwaripa, Nyanyan, and Kubwa.
STELLITE HOSPITALS are located in the suburbs, that is in the Area Councils
like Abaji, Kuje, Kwali, Zuba and Karu etc
Evidence from FCT HMIS unit shows that Malaria is the highest cause of
morbidity in FCT see fig below
28
Disease Cases Reported in FCT, 2012
4.2%
3%
5.5%
8.3%
7.8%
Malaria
AIDS/HIV
Diarrhoea
77%
Pneumonia
STI
Others
HIV/AIDS
i.
Percentage of HIV infected pregnant women who received ARV prophylaxis
to reduce the risk of MTCT was 24% in 2009 and 38.0% in 2012.
ii.
Proportion of population with advanced HIV infection and access to
antiretroviral drugs- was 72% in 2009 and decrease to 40% in 2012.
iii.
Although there was no 2011 data on the Proportion of population aged 15-24
years with comprehensive correct knowledge of HIV/AIDS, the 2010 figures
were 62% Females and 75% Males. The lack of 2012 figures was due to the
fact that no survey was done in 2011/2012.
29
TUBERCULOSIS
i.
Proportion of tuberculosis cases cured under directly observed treatment
short course was 63% in 2009, increases to69% in 2010 and decrease to 62%
in 2011 (FCT TBLCP), though record from (NTBLCP) shows 71% cure rate
with 82% treated rate.
TB Case Detection Rate under directly observed treatment short course, 30%
in 2009. There are two different sources of data for 2011; 43% (NTBCP)
and 39% (FCT, TBCP). Records from FCT, TBLCP shows that there 1714
cases detected in 2009, 1888 cases in 2010, 2038 cases in2011 and 2111
cases in 2012
Tuberculosis Situations in FCT, 2008 - 2012
2500
2038
2000
No. of Cases
ii.
1770
2111
1888
1714
1500
Cases
1000
500
0
Cases
2008
1770
2009
1714
2010
1888
2011
2038
2012
2111
Years
30
MALARIA
i.
From FCT, Routine Malaria Report, malaria prevalence among under 5
children increases from 3.64% in 2009 to 16.40% in 2012.
This
development despite the massive anti malaria advocacy programs including
the popular ‘Roll Back Malaria’ program is worrisome.
ii.
Percentage of women with pregnancy within the last 2 years who received
intermittent preventive treatment for malaria was 1.7% in 2009, 1.0% in
2010, and 1.3% in 2011, to 0.80 in 2012 as obtained from FCT, Routine
malaria report tool (RMRT).
iii.
Percentage of under- 5 children sleeping under ITN in the previous night
was 17.5% for 2011 and 59.6% in 2012.
iv.
Proportion of children under 5 with fever who are treated with appropriate
anti-malarial drugs was 31879(6.33%) in2009, and 9012(18.07%) in 2012..
Malaria Incidence among under 5 in the FCT PHC for 2012
4,286
4500
4000
3,519
3500
2,960
3000
2,299
2500
2000
1,562
2,266
0 to 11 Months
1,749
12 to 59 Months
1500
762
1000
425 424
348
Abaji
Amac
500
348
0
Bwari
Gwa/lada
Kuje
Kwali
31
Incidence
Table 1: Progress on Performance Domain
LGA
INDICATOR 2009
Reduction in Child mortality
Proportion of 83.0%
12-23 monthsold children
fully
immunized
Percentage of 12%
children under
6
months
exclusively
breastfed
Proportion of 85.0%
1 year old
immunized
against
measles
Number
of 1
new
wild
poliovirus
cases
Percentage of 74.0%
children under
5
with
suspected
pneumonia,
receiving
appropriate
treatment from
a
health
provider
Reduction in Maternal Mortality
Percentage of facilities with
at least 3 FP
commodities
in
stock
(unmet need
proxy)
MICS Survey Number
of 9.7%
clients
(NDHS
accessing
)
modern family
2010
2011
2012
88.0%
83.3%
91.0%
13.6%
14.6%
NA
95.0%
84.6%
96.0%
1
0
2
79.0%
85.0%
81.0%
24%
71.6%
50.0%
20% (NDHS)
26%
10.5%
32
planning
methods
in
health
facilities (CPR
Proxy)
FCT Bulletin Percentage of 65.0%) 72.0%
66.0%%
69.0%
pregnant
women
making
at
least 4 ANC
visits
according to
standards
NDHS
sentinel Proportion of 64.3%
70.0%
70%
survey
births attended 19,777 23,020
29,143
live 28,890
live
by
skilled
live birth birth
birth
health
personnel
Proportion of 94/713 88/792
182/793
186/791
Health Care 13.2%
11.11%
23.0%
23.51%
Facilities
providing
Basic
Emergency
Obstetric Care
Services
Reduction in the Transmission of HIV/AIDS, TB & Malaria
EOC sentinel survey
Percentage of 24..0% 23.0%
20.0%
38%
Health
Facility
HIV infected
Surve.
FASCP/PLRP/FACA
pregnant
-FCT AIDS and STI
women who
Control programey
receive ARV
prophylaxis to
reduce the risk
of MTCT.
Proportion of 72.0%
58.0%
57.0%
40.8%
population
with advanced
HIV infection
and access to
antiretroviral
drugs
61.6% (F) Not Done
Proportion of 24.2%
Not Done
75.1%(M
population
)
aged
15-24
years
with
33
Quarterly & annual
NTBLC report
(NDHS)/MICS
sentinel survey
RMRT
RMRT
comprehensiv
e
correct
knowledge of
HIV/AIDS
Proportion of
tuberculosis
cases
cured
under directly
observed
treatment
short course
TB
Case
Detection Rate
under directly
observed
treatment
short course
Malaria
prevalence
among under5 children
Percentage of
women with
pregnancy
within the last
2 years who
received
intermittent
preventive
treatment for
malaria
Percentage of
under5
children
sleeping under
ITN in the
previous
night.
Proportion of
children under
5 with fever
who
are
treated with
appropriate
anti-malarial
drugs
63.0%
69.0%
62.0%
62.0%
1894
2038
2111
18,322 58,354
(3.64%) (11.59%)
63,008(12.5%
)
82,534(16.40%
)
10,149 6,256
(1.69%) (1.04%)
6,212 (1.03%)
4,689 (0.78%)
30.0%
60.0%
59.6%
18,737 (3.72)
9,012(1.80%)
71% CR
82%Rx
1935
17.5%
31,879 24,524
(6.33%) (4.00%)
34
2.3Progress on Systems Domain
2.3.1Governance
Major strategic thrust in FCT plan include; development/review of FCT specific
guidelines consistent with provisions of national health policies and plans; new
health legislation, creation of database, Budget monitoring and Performance
management. The entire activities are expected to gulp about Thirty Four Million
Five Hundred thousand Naira (N34, 500,000.00) only expanded in 2012.
Standard mechanism is available in the FCT for grading and accreditation of
private health facilities. FCT Council for Health is an annual event, the last was
2009, and arrangement already concluded for the implementation of 2013 Council
for Health. Coordination between department agency and programe, DAP,
PHCDB, Hospital management Board and Area councils is strong, there is no
evidence of neglect of most PHC facilities.
The Health and Human services Secretariat is a product of Order 1 of 2004
(Ministry of the Federal Capital Territory Dissolution). The Secretariat is headed
by a Secretary appointed by the President but on the recommendations of the Hon.
Minister, of FCT on a Status of Special Assistant to the President of FRN.
The functions of the Secretariat include among others; Management of public
health institutions; regulations of public and private health facilities in and around
8,000 square kilometers of the Federal Capital Territory with a view to ensuring
the highest standards of health services delivery.
i.
Percentage of annual non-personnel budget executed by FCT was 41.96% in
2009 and increase to 53.1% in 2010, fell to 40.3% and 44.0% in 2011and
2012 respectively (FCT Health Bulletin, 2011).
35
ii.
FCT produced health watch every???????, the most recent edition was 2011
health bulletin, preparation is ongoing for 2012. For quick response and
comprenshive feedback on health, in 2005 FCT Administration established
call center to produce Newsletter which served as a tool for participatory
communication and good governance on health systems, the latest edition
was Vol. 1/ Number 2 Feb. 2013.
2.3.2 Service Delivery
i.
Percentage of wards with a functioning public health facility providing
minimum health care package according to quality of care standards is 25%
for 2011, 35% in 2012 and 10% for 2009 (FCT Health Bulletin 2011).
2.3.3 Human Resources for Health
Major strategic thrusts include; establishment of HRH units at HHSS and Area
Councils, recruitment, orientation, managerial and technical capacity building of
health workers established and implemented a performance management and
reward system, construction and equipping of a school of Health Technology,
engage professional associations and regulatory authorities. An estimated sum of
991 Million naira (N991, 300,000.00)
i.
Percentage of wards that have appropriate HRH complement as per service
delivery norm (urban/rural) was 30% in 2009 and 50% in 2011 (FCT Health
Bulletin 2011) while 67.5% in 2012.
ii.
Proportion of Health Professionals per population on the average was 1:446
in 2009, 1:358 in 2010, 1:440 in 2011 and 1: 486 in 2012.- Details of
specific core health work force in the table below shows HRH figures for
FCT.
36
Table 2
Health
Health
Professionals
professionals/pop. professionals/pop.
professionals/pop.
ratio 2009
ratio 2011
ratio 2012
Doctors
1/2,554
1/3,512
1/3,001
Pharmacists
1/11,335
1/12,692
1/10,705
Nurses/midwives 1/1,018
1/1,018
1/478
Laboratory
1/11,866
1/11,640
1/4,984
Health
Health
technologists
Table 3
Availability of staff by cadre in FCT PHC Facilities against set minimum standards
AVAILABLE
REQUIRED
BALANCE
1
DOCTORS
17(32%)
54
37
2
MIDWIFE
79(14%)
568
489
3
NURSE/MIDWIFE
111(58%)
190
79
4
NURSE
45 (24%)
190
145
5
CHO
60(88%)
68
8
6
CHEW
376 (73%)
514
138
7
JCHEW
255(26%)
972
717
8
PHARMACIST
4(29%)
14
10
9
PHARMACEUTICAL TECHNICIAN
10 (25%)
40
30
37
10
PHARMACY ASSSISTANT
4(7%)
54
50
11
LABORATORY SCIENTISTS
17(121%)
14
0
12
LABORATORY TECHNICIAN
19(48%
40
21
CADRE
AVAILABLE
REQUIRED
BALANCE
13
LABORATORY ASSISTANT
4(7%)
54
50
14
MEDICAL RECORDER
25(46%)
54
29
15
ENVIRONMENTAL HEALTH OFFICER
1(7%)
14
13
16
ENVIRONMENTAL HEALTH
TECHNICIAN
2(4%)
54
52
17
ENVIRONMETAL HEALTH ASSISTANT
5 (9%)
54
49
18
NUTRITIONIST
2 (14%)
14
12
19
NUTRITION ASSISTANT
0 (0%)
54
54
20
HEALTH ASSISTANT
47 (11%)
436
389
21
HEALTH ATTENDANT
130 (30%)
436
306
22
AMBULANCE DRIVERS
8 (15%)
54
46
23
SECURITY MEN
127 (29%)
436
309
24
FACILITY MAINTENANCE ASSISTANTS
35 (16%)
216
181
25
ACCOUNT CLERKS
3 (6%)
54
51
26
SCIENTIFIC OFFICER
4 (29%)
14
10
1390 (30%)
4662
3275
S/NO
TOTAL
38
2.3.4 Healthcare Financing
Financing for health
Major strategic thrusts include; Implementation of community based social health
insurance, advocate for greater public funding of the health sector through
evidence based advocacy and rigorously engage the private sector. Reinforce SHC
concessioning, Improve financial management system through FM manuals and
accounting software. Build health finance personnel capacity. The sum of 260
Million naira (N260, 700,000.00) was spend.
i.
Percentage of FCT and Area council budgets allocated to the health sectorthe FCT percentage allocation of Health Budget were; 5.06% in 2006,
6.91% in 2007, 9.06% in 2008, 9.62% in 2009 and 5.13% in 2010, 5.40% in
2011 and 4.40% in 2012. Although there was a noticeable rise in the
percentage allocation of Health Budget from 2006 to 2009, the sudden
reverse in 2010 with drastic fall in 2012 was a real setback to the Health
sector. No reason could be adduced for this but may be due to the
presumption that the FCT being the Federal Capital must be enjoying other
forms of Health Financing from some major Health Partners as well as the
MDG funds. If its true, this development will not augur well for the Health
delivery of the FCT since the partners may decide to withdraw their services
from the country at any time.
ii.
Proportion of state population falling into the bottom 2 quintiles covered by
any risk-pooling mechanisms- the FCT has no data on this.
iii.
Out-of pocket expenditure as a percentage of total health expenditure was
95% in 2009, 90% in 2011 and 80% in 2012 (National Health Accounts).
These figures are projected to fall to 80% and 70% for 2013 and 2015
39
respectively as the NHIS becomes more established. The figures may crash
further if the proposed FCT Community Health Insurance Scheme finally
takes off as planned.
It has become a common knowledge that public revenue is grossly insufficient
to guarantee sustainable health care financing. FCT has been consistence in
financing the sector and enjoys also the support of Non-governmental
organization (NGOs) and the World Bank (WB) assistance through the Second
Health Systems Development Project-II (HSDP-II). It is important to mention
here too that the percentage of support from the FCT is yet to meet the
National/WHO standard. Less than 2% of populations were covered by health
insurance scheme, there is risk pooling mechanism in the state. However more
than 70% of total health expenditure is out of pocket, the figures may crash
further if the piloted FCT Community Health Insurance Scheme finally scale up
as planned.
HEALTH BUDGET VERSUS HEALTH EXPENDITURE
YEAR
APPROVED
CAPITAL
ALLOCATION (N)
APPROVED
RECURRENT
ALLOCATION
TOTAL HEALTH
BUDGET (N)
ACTUAL CAPITAL
EXPENDITURE
ACTUAL
RECURRENT
EXPENDITURE (N)
TOTAL
EXPENDITURE
(N)
2008
2,862,363,093
3,731,680,568
6,594,043,661
2,740,730,993.00
168,314,022.00
2,909,045,015.00
2009
9,173,020,997
6,178,678,227
15,351,699,224
2,862,511,618.00
3,957,957,026.53
6,820,468,644.53
2010
8,168,150,739
10,424,481,066
18,592,631,805
1,532,806,168.60
1,353,450,574.53
2,886,256,743.13
2011
2,742,690,497
10,002,437,023
12,745,127,520
1,008,895,625.22
1,491,473,228.80
2,500,368,854.02
2012
2,642,433,150
2,112,015,798
13,363,515,169
530,417,352.00
1,423,332,287.15
1,953,749,639.00
Source: FCT Budget & Planning Unit
40
2.3.5 Health Management Information System
Major strategic thrusts include provision of HMIS minimum packages at FCT and
Area Council levels, Procurement of HIS software for SHC facilities,
Establishment of a resource center with electronic library and ICT facilities. Total
sum 610 Million naira (N610, 850,000.00) was spent
i.
Percentage of routine HMIS returns that meet minimum requirements for
data quality standard was 50.0% in 2009, 55.0% in 2010, 50.0% in 2011 and
60.0% for 2012. With adequate data training for its staff, these figures could
reach the projected estimates of 83% in 2013 and 100% in 2015.
ii.
Percentage of Disease Surveillance Reports that are submitted timely- In
2009, 61.9% while in 2010 it was 53.5%, 48.5% in 2011. The reason for the
poor performance in 2011 could not be ascertained but could be due to
inadequate funds for RI since many FCT facilities could not access their
GAVI fund in 2011. The timeliness rose in 2012 to 55.1%. It is important for
the FCT to support the return of disease surveillance report so that it will not
suffer a setback in RI activities.
iii.
Percentage of State plans and strategies that are based on routine HMIS data
to improve coverage and quality of high impact interventions was 30% in
2009, 55% in 2010, 50% in 2011 and 60% in 2012. These figures are
expected to rise to 75% and 100% in 2013 and 2015 respectively (FCT 2011
Health Bulletin)
41
2.3.6 Community Ownership and Participation
Major strategic thrusts include Reactivation of ward and village health committees,
Training of PHC health workers on community health management, Support
participation of traditional/religious leaders and opinion leaders in community
health management. An estimated sum of 24.6 Million naira (N24, 655,600.00)
only required in 2013.
i.
Proportion of public health facilities having active committees (at least 4
meetings per year) that include community representatives was 80% in 2009
and 85% in 2010, 89% in 2011 and 95% in 2012. Expect for MSS and
SURE-P facilities most of these committees are not very active due to lack
of commitment as well as the expectations of financial returns by the
members. Unfortunately, the partners who usually support the meetings have
not been consistent.
ii.
There are no records of the evidence of civil society organizations’
involvement in the development, monitoring and review of MTSS- in the
FCT for 2009 and 2010. However, 40% and 60% records for 2011 and 2012
respectively.
2.3.7 Partnership for Health
Major strategic thrusts include, Institution of joint planning, monitoring and
evaluation of programmes and projects, Exploring PPP opportunities such as
concession, coordination of meetings such as FCT Council of Health and Partners
forum,. An estimated sum of 52.5 Million naira (N52, 548,637.00) only is required
in 2013.
Health development cannot be implemented without the active participation of
major stakeholders. Government alone cannot do it and as such partnerships that
42
cut across all areas of human endeavour needs to be identified. Having four
meetings per year as indicated in the report cannot augur well for a mutually
beneficially partnership arrangement.
Professional regulatory bodies provided standards and mechanisms for graded
accreditation of private providers. This in line with professional regulatory bodies
of Medical and Dental Council of Nigeria (MDCAN), Nursing Council etc, Private
providers, such as Hospitals, Pharmacy shops and Patent Medicine Vendors are
equitably registered across the state to guarantee adequate provisions, accessibility
of essential medical services that are effective, affordable, safe, and of good
quality.
i.
Number of new PPP initiatives in the state that are implemented per yearonly one PPP initiative program was implemented in 2009 while two were
carried out in 2010, 2011 and 2012.
ii.
Availability of standards and mechanisms for graded accreditation of private
providers exist in the FCT. These are, The Annual Monitoring of Licensed
Hospitals and Annual Renewal for PPP contacts for non-clinical services.
For private providers accreditation is done by private health Establishment
regulatory committee. Pharmacy inspectorate (PHERMC) unit is also
involved
iii.
Multi-sectoral and development partner meetings held according to extant
coordination mechanism in a year are four per annum since the meetings are
usually quarterly.
43
2.3.8 Research for Health
Major strategic thrusts include; Provision of a budget line annually for research,
FCT Collaborated with the academia and research institutions in identification and
implementation of research interventions. An estimated sum of 21.1Million naira
(N21, 100,000.00) only in FCT budget for research.
It is however worth mentioning that not all the budgeted activities are provided for
in the FCT 2013 statutory budget, this means that the Administration received the
assistance of the Development Partners and NGOs working with the Secretariat to
actualize the Operational Plan. Implementation was carried out by FCT
Administration and its MDAs,
strategic partners like MSH, CSOs, WHO,
UNICEF, UNFPA, UNDP, WORLD BANK, AFDB, USAID, DFID, CIDA, EU,
JICA, Private Health Care Providers, FMOH, MRCN, NAFDAC, ODA, PEPFAR,
NIPRD, NIMR, NHIS, NHMIS, TBA, Ward Focal Person, LGA Health Educators,
Reps of VHCs and WHDCs.
i.
Percentage of health budget spent on health research and evaluation at FCT
was 0.04% in 2009, 0,025% in 2010, 0,33% in 2011 and 0.08% in 2012.
These very low figures confirm the well-known fact that many governmental
organizations do not take research very seriously. This assertion is also
reflected in the very low estimates given for 2013 (1.50%) and 2015 (2%)
projections.
ii.
There are no data for the Proportion of research and evaluation studies
undertaken on identified critical areas in the FCT SHDP framework in 2009
and 2010.However, 20% and 40% were recorded in 2011 and 2012
respectively.
44
Table 2: Progress on Systems Domain
LGA
Governance
INDICATOR
2009
Percentage of annual 41.96%
non-personnel budget
executed by the state
Number of
annual 1
Health Watch Reports
published by the state
Service Delivery
Percentage of wards 10%
with a functioning
public health facility
providing
minimum
health care package
according to quality of
care standards.
Human resources for Health
Percentage of wards 30%
that have appropriate
HRH complement as
per service delivery
norm (urban/rural).
NHMIS
Proportion of Health 1:446
Professionals
per
population
Healthcare Financing
Percentage of state and 9.62%
LGA budgets allocated
to the health sector.
Fed & State review Proportion
of state NA
per/ NHA
population falling into
the bottom 2 quintiles
covered by any riskpooling mechanisms
Budget
Out-of
pocket 95%
expenditure
as
a
percentage of total
health expenditure
Health Management Information System
Percentage of routine 50.0%
HMIS returns that meet
minimum requirements
for data quality standard
2010
2011
2012
53.10%
40.3%
44.0%
1
1
1
15%
29%
35%
NA
50%
67.5%
1:358
1:440
1:486
5.13%
5.40%
4.40%
TBD
5%
10%
NA
90%
80%
55.0%
50.0%
60.0%
45
Percentage of disease 61.9%
surveillance reports that
are submitted timely
Rapid
annual Percentage
of State 50.0%
household survey
plans
and
strategies
that
& Health facility
are based on routine
survey
HMIS data to improve
coverage and quality of
high
impact
interventions
Community Ownership and Participation
Policy
and Proportion of public 80%
implementation
health facilities having
frame work
active committees (at
least 4 meetings per
year)
that
include
community
representatives
Evidence
of
civil
society organizations’
involvement in the
development,
monitoring and review
of MTSS
Partnership for Health
Number of new PPP 2
initiatives in the state
that are implemented
per year.
Availability
of Yes
standards
and
mechanisms for graded
accreditation of private
providers.
Number
of
multi- 4
sectoral
and
development
partner
meetings held according
to extant coordination
mechanism in a year
Research for Health
FMoH Report
Percentage of health 0.04%
budget spent on health
research and evaluation
at state
FMoH Report
Proportion of research NA
53.5%
48.5%
55.1%
55.0%
50.0%
60.0%
85%
89%
95%
TBD
40%
60%
2
2
2
Yes
Yes
Yes
4
4
4
0.03%
0.3%
0.08%
NA
20%
40%
46
and evaluation studies
undertaken on identified
critical areas in the
SSHDP framework
47
d. 3.1 CHALLENGES
General Challenges
1. Duplication of roles and responsibilities, PHCs facilities are being
coordinated by PHCD, PHC departments, and Public Health department
all the FCT
2. The quality, quantity and mix of health care workers are poor with a
skewed distribution towards the FCT to the detriment of the six area
councils. For example, there are more Medical Doctors in the services of
the FCT Human and Health Services Secretariat (241) compared to the
doctors in the services of all the 6 Area Councils put together (21). In
addition, the shortfalls in the expected number of Health Professional are
almost thrice the number on ground.
3. Skew distribution of health work force to the central location rather than
rural areas
Specific Challenges
GWAGWALADA

CHALLENGES
S/N
OLD KUTUNKU
CLINIC
1
Capacity of structure is
limited e.g
accommodation for staff,
call rooms and delivery
rooms
Limited equipment
2
COMPREHENSIVE HEALTH
CARE CENTRE, DAGIN
Poor staff strength
Accessibility to the Primary Health
Centre
TOWNSHIP
CLINIC
Renovation of:
Toilets
Fence
Landscaping
Security
More staffs needed
3
Transportation e.g
Ambulance
Poor Electricity supply (wire got
disconnected from the fence)
No DRF
4
Promp payment of midwives allowances.
Ambulance Challenge
Inadequate diesel
supply.
BWARI

S/N
CHALLENGES
BWARI GENERAL
DUTSE ALHAJI
DUTSE
DEI-DEI PHC
48
1
HOSPITAL
Man power
PHC
No water
2
Free Antenetal Care
Parameter fencing
3
Equipment
4
No accommodation space
for clients
Dilapidated space
constrain
Staff shortage
MAKARANTA PHC
Inadequate extension of
structure
Under staffed
Security
Environmental
cleanliness
Under staff
Insufficient
Working
equipment
Erratic power
supply
Insufficient sits
for patients
KUJE

S/N
1
2
3
4
CHALLENGES
KUJE GENERAL
HOSPITAL
No space: hospital expansion
required
Shortage of man power.
e.g: doctors, nurses, drivers
Poor electricity supply
PEGI PHC
KUCHIAKO PHC
KIYI PHC
No light/ water
No electricity
No logistics
No proper means of
communication
No sign post for easy
location of facility
Up to date equipment not
available. E.g: delivery beds,
operating beds
No adequate male
staffs
Absence of cold
chain
Physical facilities.
e.g light and water
Staff
accommodation
No impress
No adequate training
AMAC

S/N
1
2
3
4
CHALLENGES
MAITAMA DISTRICT
HOSPITAL
Lack of accommodation
Lack of man power
Need for training of staff
New HMIS tools yet o be
used
NATIONAL
HOSPITAL
LUGBE PHC
No motorcycle for
outreach
No laboratory
equipment
No ambulance
Extra rooms needed
PIWOYI PHC
Insubordination
Negligence to work
Poor attitude to work
Poor qualified staffs
49
e. 3.2 OPPORTUNITIES
1. All the PHC centers had a centrally located accommodation for Doctors
and other staff
2. Ability to give out information during outreach
3. Constant up to date data
4. Good rapport towards patients
5. Despite the huge population at the Lugbe community the PHC services
are able to cater for the needs of the community
6. Some of the PHC conduct outreach programme
7. Ambulances services on ground for emergencies and referral
8. Existences of Partnership with MDGs and other donors
9. Payment of staff salaries as at when due
f. WAY FORWARD
Vital areas to be developed include broadening the scope of available
manpower through implementing the policy that integrates the private sector
into the health care delivery service pool as well as undertake the annual
recruitment of staff based on clearly defined parameters that match the
professional skills of the applicants with gaps derived from a need
assessment survey based on merit and geo-political representation.
LEADERSHIP AND GOVERNANCE
• Established and budgeted for FCT MTR Committee should be sustained
• Coordinating Partners Committee set up in Department of Planning
Research and Statistics be meet more periodically.
HMIS
• Validation of Data Submitted
50
• IDSR & HMIS Coordination
HRH
• Recruitment of More Skill Personnel
COMMUNITY PARTICIPATION
• Village Development Committee (VDC), Ward Development Committee
(WDC) Strengthening.
RESEARCH
• Increase Budget for Research
PARTNERSHIP
• Collaborate with Private Group e.g on Lab
SERVICES
• Warm minimum health care package (WMHCP)
• One Ambulance for each area council
• More orientation on the use of Ambulance for emergency
• IDSR and HMIS data coordination.
•
g. PRIORITIES FOR NEXT YEAR
Informed by the findings of the 2012 MTR, the under-listed immediate next steps
are proposed:
1. Pursue the launching of SSHDP
51
2. Urgent actions to be put in place to monitor the 2013 operational plans
through the NHMIS system at all levels
3. Streamline funding for the health sector in line with 2013 operational plans;
4. Align health coordination mechanisms to 2013 operational plans;
52
h. REFERENCES
1. FCT Tuberculosis & Leprosy Control Programme 2012 Reports
2. 2012 Summary report of Tuberculosis cases by Area Councils in the FCT
3. Health Allocation As Percentage of Total FCT Budget, 2008 - 2012
4. Summary of Family Planning Activities In FCT, 2012 (Jan - Aug)
5. Statistics of Core Health Professionals In Government Hospitals, FCT,
2012
6. National Facility Art Monthly Summary FCT; Jan - Dec 2012
7. FCT Health Status/Indicators For 2012
8. FCT 2012 RI Analysis
9. Report For The FCT 2011 Jar
10.Routine Monthly Notification Form FCT (IDSR 003) JanDec 2012
11.NDHS/MICS-Health Facility Survey 2008
12.HMIS- Disease Surveillance (MICS 2007)
13.NIPRD 2013 MIDTERM REPORT ON NSHDP
14.Brief on nutrition program. MTR-FMOH 2013; UNICEF
15.FCT Strategic Health And Development Plan Oct 2009
16.National Bureau of Statistics
17.2006 Core Welfare Indicator Questionnaire (CWIQ) Survey
FCT Summary
18.FCT Strategic Health Development Plan Result Matrix
19.FCT,SHDP Annual Review Report
20.AC Annual Report
21.Facility Survey Report
22.NPHCDA Survey Report
53
23.HDC Reports
24.State and ACs Budgets
25.National Health Accounts 2003 - 2005
26.Research Reports
27.State budget
28.Health Research Communication Strategy
29.2010 National immunization Coverage Survey
30.Nigeria Malaria Indicator Survey 2010
31.National immunization Coverage Survey; Review of
Performance for the 2003‐2010 Surveys by States
32.Nigeria Annual Health Sector Report, 2010
33.Nigeria Health Sector Performance Report 2011
34.Nigeria Multiple Indicator Cluster Survey 2007
35.Nigerian HRH Statistics As At 2009.
36.NSHDP National Result Framework
37.Weekly Epidemiology Report Federal Ministry of Health –
Nigeria Issue: Volume 1 No. 21 5th August, 2011.
38.Report of the Vision 2020National Technical Working Group
On Health July, 2009
54
Annexes
Annex 1
HHSS MEETING OF PROGRAMS OFFICERS ON 2012 JAR/MID-TERM REVIEW OF FCT
SHDP 29TH JULY 2013
S/
N
NAME
PROGRAM/DEPAR
TMENT
DESIGNATI
ON
PHONE
NUMBER
E-MAIL
1
DR AMINAT
ZAKARI
H(M&E)
080331356
262
mina0177@yahoo.com
2
DR UDUAK
UWAKMFON
M&E
070361135
62
druwakmfon@yahoo.c
om
3
DR INI EKONG
DISEASE
SURVEILLANCE/
PHD
TUBERCLOUSIS &
LEPROSY CONTROL
(TBLCP) PHD
MDG/ HPRS
DO
inijust@yahoo.co.uk
4
DR CHINENYE
ORJIOKE
DAHIRU
MOHAMMED
KATAME M.
TANKO IYK
EKWUEME, CC
HRH/HPRS
DO
M&E/ HPRS
STAT I
SHS/PHCDB FCT
HON SHS
NUTRITION/PHCDB
FCT
BUDGET/HHSS
PNO
DISEASE CONTROL
FCT, PHCDB
NPI FCT PHCDB
PNO
PSD, HHSS
DD TM/M&E
FANC/HHSS
DO
NURSING DEPT.
CNO
HMIS/HHSS
STAT II
HPRS
FCT PHCDB (WASH)
ASST.
ADMIN
OFFICER
SH
080876235
74
080373980
28
080361822
32
080338629
99
070378506
57
080359668
55
080606766
59
080552502
38
080981364
36
080543477
74
080333502
64
080321003
03
070885526
60
maykalba@yahoo.com
FCT PHCDB / CHILD
& ADOLESENT
HEALTH
HPRS/HHSS
CH/AH
COORDINAT
OR
PPO
080357489
18
080336159
03
080360113
84
esmondwil@yahoo.co
m
5
6
7
8
9
10
11
12
13
14
15
16
17
18
WILSON A.
ASO
GARBA
MOHAMMED
TANKO
CHADWAFWA
BONIFACE E.
IKWU
DR OZY
OKONOKHUA
JUSTINA
ADANU
HAMMAN G.
SAMSON
WILLIAMS
BIODUN
DR M.D
KALBA
BALARABA
SANI
DESMOND
EMEREONYEO
POR
REP SID
drchinny@yahoo.com
dahmohkid@yahoo.co
m
clareekwueme@yahoo.
com
Abu2312002@yahoo.c
om
fctimmunization@yah
oo.com
lebon66@yahoo.com
Imuse288@gmail.com
adanudohi@yahoo.co
m
samneo.hamman3@g
mail.com
babyjoker1226@yahoo
.com
faty-jibir@yahoo.com
55
19
KWE
DR M.B.
KAWU
HPRS
DIR HPRS
080331108
09
drmbpriya@yahoo.co
m
20
AZEEZ
BUKOLA
DO (PPP/NGO)
ACSO
080600658
78
bjuliananh@yahoo.co
m
21
IKWUBIELA S.
ADEM
HPRS
080714270
99
ikwubielaode@yahoo.
com
22
JAMES J.
ALEGE
HMIS/HPRS
HEAD
(RESEARCH
DEPT.)
HEAD(HMIS
)
080596671
77
jjalege@yahoo.com
23
DR YAKUBU
CLEOPHAS
DR YAKUBU
MOHAMMED
OLESEGUN O.
FEMI
HHSS,PHD, RBM
PM RBM
maraziny@yahoo.com
FASCP, PHD, HHSS
HPRS
HEAD(HIV/A
IDS)
DO HA
080231520
18
080362367
00
080378797
08
PHARM
SAMSON
ERIBA
HPRS
HEAD(P&P)
080331416
92
eribsam@yahoo.com
24
25
26
yaaakooo@yahoo.com
sfakehinde@yahoo.co
m
56
NAMES OF INTERVIEWEE’S FOR THE 2012 JAR/MID-TERM REVIEW
A. AMAC
S/N
1
2
3
NAME
Ndanusa .K. Saba
Bello Raliyat
Ebahoro Charles
DESIGNATION
HHF
MSS Midwife
M&E/STATISCIAN
OFFICE
Lugbe PHC
Lugbe PHC
Maitama Distric
Hospital
Maitama Distric
Hospital
Maitama Distric
Hospital
Maitama Distric
Hospital
Piwoye PHC
Dutse Garki PHC
PHONE No
0813461630
0803995265
08034460852
4
Jibrin .S. Nuru
Admin (Registry)
5
Mrs Onyenankeya Oluchi
6
Pharm (Mrs) Virginia Adeoye
Asst. Chief Nursing
Officer
ART Pharmacy
7
8
Mrs Faustina Onyewneke
Mrs Taiwo Shola
DESIGNATION
C.N.O
C.N.O
RMRN
ACCHO
OFFICE
Bwari General Hospital
Dutse Alhaji PHC
Dei-Dei PHC
Dutse Makaranta PHC
PHONE No
08036227952
08052402223
07060735314
08036987134
PHONE No
08023222663
08053464507
08096222878
08186888924
RNM
08033811530
07026106031
08054149555
08025043499
B. BWARI
S/N
1
2
3
4
NAME
Mrs Rosana .B. Nwgiwu
Mrs Raliatu .A. Bello
Mrs Esther Tuma
Mr Goje Kyanta
C. KUJE
S/N
1
2
NAME
Dr Egbi Tabunde
Mr Noah Adaji
DESIGNATION
Medical Director
Ass PHC Cordinator
OFFICE
Kuje General Hospital
Kuje Area Council
3
4
5
6
Mr Yunusa .M. Agabe
Mrs Clara Kolawole
Mrs Maryam Buhari
Mr Domshak Habila
Ass M&E Officer
Head(PHC)
Head(PHC)
Head(PHC)
Kuje Area Council
Kiyi PHC
Kuchiako PHC
Pegi PHC
D. GWAGWALADA
S/N
1
NAME
Dr Bob Ukonu
DESIGNATION
Consultant
OFFICE
UATH Gwagwalada
PHONE No
57
2
Mrs Anna Zemo
3
4
5
Mr Yusuf Samo
Mr Elijah Zakwoyi
Mr Douglas Okoye
Physician/Dermatologist
Incharge
Dagin comprehensive
health clinic
SCHEW
Old Kutunku Clinic
LGA Cordinator
Incharge
Kutunku Township
Clinic
08136437107
08039640116
NATIONAL HOSPITAL
S/N
1
NAME
Dr J.A. MOMOH
DESIGNATION
Dr. Clinical
Services/CMAC
OFFICE
CMAC
PHONE No
08033118373
Annex II
ATTENDANCE OF FIELD TEAM AT THE TOT ON FIELD WORK AND
USE OF TOOLS
S/
N
NAME
PROGRAM/DEPART
MENT
DESIGNAT
ION
1
PHARM
SAMSON
ERIBA
OLESEGUN O.
FEMI
HPRS
HEAD(P&P)
HPRS
DESMOND
EMEREONYEO
KWE
DR CHINENYE
ORJIOKE
DAHIRU
MOHAMMED
HAMMAN G.
SAMSON
WILLIAMS
BIODUN
2
3
4
5
6
7
PHONE
NUMBE
R
08033141
692
E-MAIL
DO HA
08037879
708
sfakehinde@yahoo.co
m
HPRS/HHSS
PPO
08036011
384
esmondwil@yahoo.co
m
HRH/HPRS
DO
drchinny@yahoo.com
M&E/ HPRS
STAT I
HMIS/HHSS
STAT II
HPRS
ASST.
ADMIN
08037398
028
08036182
232
08032100
303
07088552
660
eribsam@yahoo.com
dahmohkid@yahoo.co
m
samneo.hamman3@gm
ail.com
babyjoker1226@yahoo.
com
58
OFFICER
Pharm Samson DPRS
8
9
Kayode
MSH
Health
Advisor
AGENDA
Stakeholders Validation Meeting of FCT 2012 JAR/ MTR Report at HMB Conference
Room
5th August 2013
1. Opening Prayer
2. Introduction of Participants
3. Opening brief by Director HPRS – Dr M B Kawu
4. Presentation of findings and draft report by the Consultant- Dr M
J. Saka
5. Remark by Development Partners (MSH, WHO, UNICEF, UNFPA
etc)
59
6. Observations/Discussions -All
7. Next Step (Recommendation/challenges/way forward)
8. Closing remark
9. Closing Prayer
ATTENDANCE AT MTR VALIDATION MEETING OF DRAFT 2012 MID-TERM REVIEW OF FCT
SHDP 5TH AUGUST 2013
S/N
1
NAME
ELIJAH ZAKWONI
2
DR. APAGU
GADZAMA
DR AMINAT
ZAKARI
DR(MRS) F.O.
MOMOH
Dr TANBUWE .E.
3
4
5
6
DR CHINEYE
ORJIOKE
PROGRAM/DEPT
M&E/PHC
G/LADA
M&E DESK OFF
FCT PHCB
M&E PHD
DESIGNATION
M&E OFFICER
PHONE No
08033176038
E-MAIL
Wlidia2007@yahoo.com
M&E DESK OFF
08036182337
dannyabuth@yahoo.com
H(M&E)
08033156262
Mina1077@yahoo.com
D(PH)/ .PH DEPT
D(PH)
08037871487
fomomoh@yahoo.com
M.D KUJE GEN.
HOSP
DO HRH, HPRS
M.D KUJE GEN
HOSP
MO HPRS
08023222663
egbioe@yahoo.com
08037398028
drchinny@yahoo.com
60
7
9
DESMOND
EMEREONYEOKWE
DR MATTHEW
ASHIKENI
JUSTINA ADAMU
10
MRS E. CHUKWU
11
MRS L. KAURA
12
13
14
15
DR BALARABE H.S
DR GOJI S.D
ERUBA J.E.E.
JOSEPH UGBAH
16
NURUDEEN .M.
BASHEER
DAHIRU
MOHAMMED
IKE KENECHUKWU
NPHCDA
NPHCDA(ZTO)
08032488393
M&E HHSS
STAT
08036182232
M&E UNIT HHSS
PPO
08037875854
FHSS
PM
08034647273
AMAC
ASST. M&E
08039344436
21
22
23
DR EVANS
ONYEKELE
GOODNEWS
APOLLOS
JAMES J. ALEGE
IGWEONU C.J
MR NIYI ODUNEYE
24
EJEMAI IWERE
25
26
27
DR A.M. MAI
PHARM A.M.
KAZZAH
MAKKA I.
28
ROSARA NWAIWU
29
30
HHSS –SEC
OFFICE
HMB
PHARM SERVICE
HHSS
BWARI GEN
HOSPITAL
BWARI GEN
HOSPITAL
A/C FHS-AMAC
HMIS-HPRS-HHSS
OYERINDE HELEN
HAMMAN
SAMSON
WILLIAMS BIODUN HPRS
8
17
18
19
20
31
HEALTH
PALNNING HPRS
DIRECTOR DC-FCT
PHCB
NURSING DEPT
HSS
NURSING DEPT
HMB
KUJE AREA
COUNCIL
PHC, FCT PHCB
BWARI A/C
FMOH
FMOH
PHPO
08036011384
esmondwil@yahoo.com
DIRECTOR
08033043920
mashikeni@yahoo.com
REP DNS
08033350264
adamuolohi@yahoo.com
REP DNS
08025319436
eico@yahoo.com
REP H.O.D
08034544680
lyatukaura@yahoo.com
DIRECTOR
HOD-HEALTH
SNO
STAT OFFICER
07032069722
08037054588
08033218147
08032856551
deeza2612@gmail.com
sundaygoji@yahoo.com
jeeraba@yahoo.com
Josephine.ugbah@yahoo.c
om
basheernurudeen@yahoo.
com
damohked@yahoo.com
HMIS- HHSS
HHSS BUDGET
HHSS-SEC OFFICE
ASST DIRECTOR
SA(ADMIN)
SHHS
SA(TECHNICAL)
HHSS
GM
DPS
08059667177
08039175575
08065781953
kenechukwujob@yahoo.co
m
onyekeleevans@yahoo.co
m
goodnews2polos@yahoo.c
om
jjalege@yahoo.com
igweonuchita@yahoo.com
niyineye@yahoo.com
08091845760
ejemaii@yahoo.com
08030908456
08034530967
aminumai@gmail.com
kazzahus@yahoo.com
M&E
08033573201
CNO
08036227982
rosie@yahoo.com
REP H.O.D
ASST. HMIS
OFFICER
ADMIN ASST.
08168607774
08032100303
helenajerinde@yahoo.com
samneo.hamman3@gmail.
com
babyjoker1226@gmail.co
m
07068552660
61
32
33
AZEEZ. J. Bukola
PHARM SAMSON
ERIBA
HPRS
HPRS
DO PPP/NGO
H(P&P)
08060065878
08033141692
bjulianah@yahoo.com
eribasam@gmail.com
62