2011Joint Annual Review – Kogi State Strategic Health Development Plans
By
Dr Saka M.J
March 2012
i
ACKNOWLEDGEMENT
Kogi State Joint Annual Review 2011 documents the process, results and findings, opportunities
and challenges, as well as, recommendations and next steps the State Strategic Health
Development Plan (SSHDP).
The JAR Review Team appreciates the leadership demonstrated by the Honourable
Commissioner for Health (Dr Mrs Dorcas), the Permanent Secretary Ministry of Health (Alhaji
Ahmed Tijani), The Director of Planning Research and Statistics Dr E.E Idachaba and the Top
Management Committee of the SMOH which provided support to the planning and execution of
the JAR is greatly acknowledged and appreciated.
Specific thanks to Chief Medical Director of Kogi State Specialist 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,
CSOs, and LGA focal person, communities’ members. Development Partners namely; UNICEF,
WHO, MSH, ICAP, SFH and the World Bank. These agencies not only participated actively and
respond to short call during review process.
ii
TABLE OF CONTENTS
Pages
Cover Page ………………………………………………………………………………………. i
Table of Content…………………………………………………………………………………..
Acknowledgment………………………………………………………………………………..ii
Acronyms………………………………………………………………………………………..iv –vii
Executive Summary ……………………………………………………………………………VIII-IX
1.0
1.1
Introduction …………………………………………………………………………………1
Background …………………………………………………………………………………….…1
1.2
Situation Analysis ………………………………………………………………………….2-3
1.3
Methodology …………………………………………………………………………. ……...3 -5
2.0
Results and Findings……………………………………………………………………………….
2.1 Process of roll out and Implementation of the State SHDP ……………………..6
2.2 Progress on Performance Domain ………………………………………………………..6
2.2.1
Reduction in Child Mortality …………………………………………………………..6
2.2.2
Reduction in Maternal Mortality ………………………………………………………6
2.2.3
Reduction in the Transmission of HIV/AIDS, TB & Malaria …………………..7
2.3
Progress on Systems Domain Facilities…………………………………………
2.3.1
Governance ……………………………………………………………………………………8
2.3.2 Service Delivery ………………………………………………………………………………..9
2.3.3 Human Resources for Health………………………………………………………………..10
2.3.4. Health Financing ……………………………………………………………………………….11
2.3.5. Health Management Information Systems ………………………………………………..12
2.3.6. Community Ownership and Participation………………………………………………….13
2.3.7. Partnership for Health…………………………………………………………………………14
2.3.8. Research for Health ……………………………………………………………………………14
3..0 Challenges and Opportunities ………………………………………..
iii
3.1. Challenges…………………………………………………………………………………………15
3.2. Opportunities……………………………………………………………………………………….16
4. 0 Way Forward and Priorities for Next year……………………………………………………..17
4.1. Way Forward ………………………………………………………………………………………..17
4.2 Priorities for Next Year ……………………………………………………………………………18
5.0 Annexes ………………………………………………………………………………………………19
Annex 1 List of Person Interviewed at the State level ……………………………………….19 -23
Annex 2 List of Person Interviewed in the Field ………………………………………………24 -25
Annex 3 General Findings for field Visit (Health facilities Disaggregated by LGA)………26-32
Annex 4 List of attendance at the validation meetings ……………………………………….33-34
Annex 5. List of Joint Annual Review Members …………………………………………………...35
iv
LIST OF ACRONYMS
AIDS
Acquired Immune Deficiency Syndromes
ANC
Ante natal Care
ART:
Acute Respiratory Infection
ATM
Aids Tuberculosis and Malaria
CBHI
Community Based Health Insurance Scheme
CHEW:
Comm. Health Extension Workers
CHEWs
Community Health Extension Workers
CHO:
Comm Health Officer
CPR
Contraceptive Prevalence Rate
DDPHC
Deputy Director Primary Health Care
DMS&T
Directorate of Medical Services and Training
DNS
Directorate t of Nursing Services
DPHC
Directorate of Primary Health Care
DPRS
Directorate of Planning, Research and Statistics
DPS
Directorate of Pharmaceutical Services
FCT
Federal Capital Territory
FP
Family Planning
HCT:
HIV Counseling & Testing
HDCC
Health Data Consultative Committee
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
v
ITNs:
Insecticide Treated Nets
JAR
Joint Annual Review
KSPHCDA
Kogi State Primary Health Care Development Agency
LGA
Local Government Area
LGA
Local Government Area
M& E
Monitoring and Evaluation
M&E
Monitoring and Evaluation
MCH
Maternal and Child Health
MDCN
Medical and Dental Council of Nigeria
MDG
Millennium Development Goal
MNCH
Maternal neonatal Child Care
MSH
management Science for Health
MSS
Midwife Service Scheme
MSS
Midwifes Service Scheme
MTSS
Mid-term sector strategy
NDHS
National Demography Health Survey
NGOs
Non-Governmental Organizations
NHMIS
National Health Management Information Systems
NSHDP
National Strategic Health Development Plan
PHC
Primary Health Care
PMTCT
Prevention of Mother to child Transmission
RN/RM:
Registered Nurse /Midwives
SHC
Secondary Health Care
SMOH
State Ministry of Health
SMOH
State Ministry of Health
SSHDP
State Strategic Health Development Plan
vi
TB
Tuberculosis
TBA
Traditional Birth Attendance
TBL:
Tuberculosis and Leprosy
UNICEF
United Nation Children Fund
VVHW:
Voluntary Village Health Worker
WB:
World Bank.
WDC
Ward Development Committee
WHO
World health Organization
vii
Executive Summary
Kogi State is heterogeneous, richly endowed with natural resources, such as kaolin, iron ore
etc. Form the last 2006 National Population Census Figure, a total population of 3,314,043
million people, 50.5 % of the population was made up of males while 49.5% was for the female.
The JAR is a sector-wide evaluation exercise jointly conducted by government at all levels,
development partners and civil society organizations for joint monitoring, evaluation and
validation of the successes and/or limitations recorded within the health system.
In achieving the 2011 JAR objectives desk review 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. This in addition to assessment of twenty
five health facilities in six LGAs, spread across the three senatorial district of Kogi State.
The findings showed that the State is on course in reduction of morbidity and mortality rates due
to communicable and Non communicable diseases to the barest minimum, SSHDP was used
as a guiding document in development of annual operation plans, Midterm Sector Strategy
(MTSS) and LGA action plans for strengthen the State Health System to be able to deliver
effective, quality and affordable health. However, health system is weak and the causes are
multi-dimensional. The health sector is underfunded and overstretched by a burgeoning
population. Similarly, a culmination of decades of neglect is responsible for high disease
burdens, decaying physical facilities, obsolete equipment among others. Launching of SSHDP
and signing of bill for the establishment KSPHCDA are still pending by the Executive Governor.
SMOH developed health watch every 3 years, the most recent edition was 2008 -2011 health
bulleting. According to Kogi state approved budget for 2009 and 2011, 5.25% and 6.93% of
state budget was allocated to health respectively. SMoH non personnel budget executed for
2009 was 9.6% while 1.46 % was recorded in 2011. Children between 12-23 months-old that
were fully immunized decrease from 81% to 52%. In 2009 six new wild poliovirus cases was
detected, Non in 2011 till date, Most (80%) of the skilled manpower in the state are
concentrated in the urban area specifically Federal Medical Center Lokoja and Kogi State
Specialist Hospital with only 20% in the rural area. Doctor populations ration is1:38092, Nurses
Population ration is 1:84,975, Pharmacist population ration is 1:132,562 while Lab Scientist
Population Ratio 1:144,089. PHC facilities in the state are about 80% health posts, a substantial
proportion of the facilities are in a state of poor repair. PHC facilities had a mean of 4.0 staff per
facility; with 90% of the MSS facilities has functional ward development committees. The
chances that other PHC facility has a village development committee is 83%, however, not more
than 15% of these facilities (mostly MSS) had active health management committee (at least 4
meetings per year that include committee representative).
Challenges identified include low level of awareness of the SSHDP by health workers at LGA
level, the low level of budgetary allocation and untimely release of fund at all levels, weak
implementation of SSHDP and coordination structures, among others. Opportunities include
harnessing the platform for integration of immunization, ATM services with MNCH, the MSS and
CHEW initiatives increasing pool of HRH, evolving MTSS processes to inform results focused
viii
budgeting, as well as the CBHIS and other community financing schemes to cover the informal
sector and reduce the high out-of-pocket-expenditure for health.
Recommendations proffered include; Governments and partners to support delivery of an
essential package based on SSHDP to avoid duplication of effort. Strengthening community
financing mechanisms including CBHIS and effort should be made to domesticate MSS
programme in rural community. Conduct of joint quarterly review by department/ unit heads.
Immediate next steps for 2012 are: launching of SSHDP, sign into law SPHCDA Bill,
establishment of mechanism for SSHDP M&E and Coordinating Partners Committee set up in
Department of planning research and Statistics.
ix
1) INTRODUCTION
1.1
BACKGROUND
a) The basis for undertaking the JAR
The Joint Annual Review (JAR) is an independent, transparent assessment system for joint
monitoring, evaluation and validation of the successes and/or limitations recorded within the
health system, by government and its health partners at all levels. Specifically, the JAR process
in Nigeria has been established to monitor progress towards achieving annual targets in the
National Results Matrix; in addition it monitoring government and partners’ commitments in the
Nigeria Country Compact. The JAR is a sector-wide evaluation exercise jointly conducted by
government at all levels, development partners and civil society organizations. The theme
for the 2011 JAR is “NSHDP: Progress, Opportunities and Challenges in 2011”.
b) The Objectives of the Joint Annual Review are therefore to:
1. Assess how far the recommendations of the 2010 JAR were implemented at the state
level;
2. Take stock of progress made in implementing the Health Plans focusing on results
achieved at the Kogi State level,
3. In comparison with milestones of the Kogi State’ Results Framework;
4. Review the systems and processes that have been put in place for the successful
implementation of the Health Plan;
5. Review the Kogi SSHDP implementation structures and their effectiveness.
6. Provide an objective analysis of the systems, processes and performance elements and
agree on modalities for improvement
7. Agree upon specific priorities for the following year;
8. Use this as a platform to progressively harmonize multiple partner supported annual
reviews into a single joint annual review for the health sector.
Scope and Focus: Look into substantive issues as defined in the results matrix as the plan
would have had 24 full months of implementation. It captured evidence-based information that is
available on the system, process and performance domains. Under the Systems-Process
Domain attention focused specifically on indicators related to the following priority areas of the
SSHDP: Leadership and Governance, Service Delivery, Human Resources for Health (HRH),
Health Financing, NHMIS, Community Participation, Partnerships for Health Development; and
Research. Specifically, the status of the above indicators were reviewed and reported on:
1
1.2 SITUATION ANALYSIS
a) Socio-economic situation of the State
Kogi state of Nigeria was created on the 27th August, 1991 from the Eastern part of the then
Kwara State and the western part of the then Benue state. The two areas made up what was
formerly called ‘Kabba province’ The state occupies the central part of Nigeria and it is unique
for serving as the belts for the two major rivers in Nigeria – Niger and Benue. Indeed, its state
capital, Lokoja is the meeting point of the two rivers hence the appellative, ‘Confluence State.
The state occupies an area of 28,312.6 square kilometers. It shares common boundaries with
ten (10) states and the Federal Capital Territory (FCT). To the North; it shares boundaries with
Niger, FCT, and Nassarawa, to the West by; Kwara, Ekiti, Ondo, Edo, and Delta, while to the
East by; Benue, Anambra and Enugu states. Kogi state is made up of 239 wards, in 21 LGAs
and 3 Senatorial districts. Demography:-The State had a total population of 3,314,043 million
people in the last 2006 National Population Census Figure. The 2006 census revealed that 50.5
% of the population was made up of males while 49.5% was for the female. Meanwhile, the
Total Population Projection for 2010 revealed that the state had a total population of 3,729,983
million people. The population of children under 1 year of age is 149,199, while under 5 years is
745,997 and children under 15 years of a age is 1,741,902.The Projection further revealed that
women of child bearing age (18-49) years is 820,596 people and Pregnant women is 186,499.
People;- Kogi state is highly heterogeneous due to her location. The major indigenous ethnic
groups in the state are: Igala, Ebira and Okun. Others include; Egbirra-koto, Bassa-komo,
Bassa-Nge, Nupe and Ogori. Numerous other Nigerian ethnic groups from outside the state
have found a safe haven in the state. Occupation; Agriculture remains the main occupation of
the people (over 70%), cultivating cash and food crops extensively (yam, rice, maize, guinea
corn & beni-seed), while the tree crops include; palm oil, cashew, cocoa and coffee. expectedly
fishing is also a very significant occupation in the state. Economic Resources;- Kogi state is
richly endowed with natural resources, which include; coal, limestone, marble, feldspar, clay,
kaolin, iron ore, cassiterite, columbite, tantalite, quartz, talc 7 mica. Sequel to the large deposits
of solid mineral resources the Ajaokuta steel company and Obajana Cement Company have
been established in the state.
b) The Context Of The Health System In The State
Kogi State envisioned to reduce the morbidity and mortality rates due to communicable
diseases to the barest minimum; reverse the increasing prevalence of non-communicable
2
diseases; meet global targets on the elimination and eradication of diseases; and significantly
increase the life expectancy and quality of life of Nigerians. With mission “To develop and
implement appropriate policies and programmes as well as undertake other necessary actions
that will strengthen the National Health System to be able to deliver effective, quality and
affordable health. Overarching goal of the Kogi SHDP is to significantly improve the health
status of Kogi people through the development of a strengthened and sustainable health care
delivery system” However, the health system is weak and the causes are multi-dimensional.
The health sector is underfunded and overstretched by a burgeoning population. Similarly, a
culmination of decades of neglect is responsible for high disease burdens, decaying physical
facilities, obsolete equipment among others.
1.3 Methodology
a) Methods: Documentary Review; Interviews of stakeholders and Field Visits
The State JAR Core and Reference committees made up of the Honorable Commissioner of
Health (Chairman), Permanent Secretary, Director Health Planning Research & Statistics
(DPRS), Director of Primary Health Care (DPHC) in the State Ministry of Health. Technical
Working Subcommittee made up of Director of PHC, State Epidemiologist (DDPHC), Deputy
Director PRS, and State HMIS Officer, the committee is coordinated by Director of Planning
Research and Statistics with responsibility for planning and coordinating the joint annual review
process. The sub-committee also had representation from the WHO, MSH and UNICEF. The
sub-committee had a channel of reporting to the Permanent Secretary for implementation,
which in turn reports to the core committee chaired by the Honorable Commissioner for Health.
The process for undertaking the joint annual review was divided into phases as follows:
Phase 1: Preparatory activities for the JAR
This phase recorded the development of the outline and framework for the JAR process,
followed by the development of a comprehensive JAR concept note, which clarified the
objectives and scope, while laying out the JAR 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: Systems and performance review tool which guided the desk review
2. Tool 2: For interview of stakeholders at the state level
3
3. Tool 3: LGA interviews and Health Facility spot check
4. Tool 4: SMOH Programme instruments
Preparatory phase ended with an orientation meeting of stakeholders and training of the state
team on JAR tools. The Permanent Secretary MOH chaired the events on the 8th march 2012 at
the State MoH Conference hall. See annex 1 for meeting Agenda, participant list and report
of orientation meeting
Phase 2: Data collection to inform the JAR process
This comprised of a two-prong approach namely the desk review and joint field assessments,
both of which were guided by the three JAR tools developed in Phase 1.
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 State technical working team for JAR, supported by the State HMIS and other
JAR Committees. Sources of secondary data and information that informed the desk review
process included the State SHDPs, State/LGA Operational Plans, routine State HMIS data,
State IDSR report, State Health Bulleting 2008-2011 edition, State budget documents. In
addition, guided by a structured format and tools, Units and Department submitted individual
progress reports on the implementation of State SHDPs, which served as additional resource
materials. This includes reports from units’ desk officers for sub account, health insurance,
Nutrition for breastfeeding etc and department’s reports. Diseases Specific reports on
HIV/AIDS, malaria, Immunization etc, other reports consulted are MICS 2007, NDHS 2008,
Routine Immunization Data Quality Survey, Medium term sector strategy documents and other
relevant official programme and development partner reports.
Joint Field Assessment Visits:
In line with the adopted phased approach for field assessments, the selection of 6 LGAs, 25
HFs from the 3 senatorial district for field visits was based on the defined criteria of
performance, as follows:




Ante-natal care visits;
Skilled birth attendance at delivery;
Full immunization of children 12-23 months;
Contraceptive prevalence rate;
4


Stunting of under-five children;
Treatment of childhood illnesses – pneumonia, malaria and diarrhea.
Table 1;-Health Facilities Within LGAs in a Senatorial District
SENATORIAL
DISTRICT
WEST
Central
10 HC FACILITY
SELECTED
LGAs
Lokoja
Model PHC Felele
Specialist Hospital and FMC Lokoja
Kabba Bunu
PHC Egbeda, Ayede and Odoape
GH. Kabba, MCH Owode
Okehi
PHC Obeiba, Okaito, Ironkovi
GH Obangede, BHC Obangede
Okene
East
20 & 30HC FACILITY
MCH Okene, GH Okene
Ankpa
PHCs Ofugo, Ojoku, Ogodo
GH Ankpa, PHC Ankpa
Dekina
CHC Anyigba, MCH Dekina, MPHC Ajiolo
DRH Anyigba, MCH Anyigba
13
12
Total
A total of six (6) LGAs were visited namely, Anka and Dekina (East Senatorial), Okehi and
Okene (Central), and Kabba Bunu and Lokoja (West). A joint team of government, partners,
private sector and CSOs visited al the facilities, from each senatorial district. During the field
assessments, health facilities were visited and assessed using the facility spot check tool by the
teams in addition to conducting structured interviews of key stakeholders including policy
makers, civil servants and representatives of civil society organizations. Membership of the
federal and state teams included representatives of the FMOH, National Primary Health Care
Development Agency (NPHCDA), and National Health Insurance, and Development Partners
(DPs). State level participation in the review was drawn from the State Ministry of Health
(SMOH) department and Units. LGA PHC Coordinators, as well as representatives of other line
ministries, CSOs, Private Sector and Professional bodies. The consultants assigned to each
state team were tasked with the conduct of in-depth analysis of the data gathered from the desk
review and field visits at state. See annex 2 and 3 for the contact list of people interviewed and
outcome of field visit
The field visit team collates, compiled the draft report and facilitated the validation meeting
chaired by the Honorable Commissioner for Health Dr Mrs Dorcos.S. Onuarinya .See annex 2
for attendance list
5
2) RESULTS AND FINDINGS
2.1 Process of roll out and implementation of the State SHDP
No specific mechanism for the implementation of SSHDP as the launching of the SSHDP is still
pending, however, operation activities, Local Government Operational plan and State MTSS
were developed based on SSHDP. It is hope that established advocacy and think thank
committees with members of State assembly will facilitate approval by executive Governor of
the State.
2.2 Progress on Performance Domain
2.2.1
I.
Reduction in Child Mortality
In 2009 and 2011 respectively 81% and 52% of 12-23 months-old children were fully
immunized
II.
Only 14.6% of children under 6 months exclusively breastfed in 2011
III.
In 2011, 47 % of 1 year old were immunized against measles while
IV.
In 2009 six new wild poliovirus cases was detected, Non in 2011 till date
V.
Record from State Health Bulletin shows that 1.5% of children under - 5 with suspected
pneumonia, receiving appropriate treatment from a health provider
VI.
53% of newborns and mothers were visited within 72 HOURS of delivery by a skilled
health care provider
2.2.2
Reduction in Maternal Mortality
I.
63% of the facilities had at least 3 FP commodities in stock (unmet need proxy)
II.
12,713 Number of clients accessing modern family planning methods in health facilities
(CPR Proxy)
III.
68% of pregnant women making at least 4 ANC visits according to standards
IV.
% (16299) in 2009 of births attended by skilled health personnel it decrease to 0.7%
(13,903) in 2011
6
V.
In 2009 9.3% of Health Care Facilities are providing Basic Emergency Obstetric Care
Services while 11.3 % recorded in 2011
Health care delivery in the state is the responsibility of the three tiers of government. That is,
Tertiary care (Federal and State Government), Secondary care (State Government) and
Primary Health care (LGAs). There are four (4) health training institutions in the State. Two of
these institutions are run by the state, while two are mission owned with state government
subventions. These are: School of Nursing Obangede (State), School of Nursing & Midwifery,
Egbe (Mission), Grimard School of Midwifery, Anyigba (Mission) and School of Health
Technology, Idah (State). Schools of Nursing, trains nurses only, while the School of Health
technology trains; Community Health Extension Workers (CHEWs), Environmental Health
Officers, Laboratory assistants and Health Management Information System (HMIS) Officers.
2.2.3
Reduction in the Transmission of HIV/AIDS, TB & Malaria
HIV/AIDS
I.
In 2009 and 2011, 6.0% of HIV infected pregnant women received ARV prophylaxis to
reduce the risk of MTCT.
II.
In 2011 only 10,500 population with advanced HIV infection had access to antiretroviral
drugs
III.
In 2009 5.1% of population aged 15-24 years with comprehensive correct knowledge of
HIV/AIDS, with 5.8% in 2011.
HIV/AIDS epidemics are of great concern to the world community. The North central zone of
Nigeria to which Kogi State belongs has the highest prevalence rate of HIV/AIDS of 10.00% that
makes kogi state to be prone to trans-border transmission. Kogi state is one of the states that is
mostly affected by this dreaded disease. The HIV – sero – prevalence rate in Kogi is not sharing
a significant improvement at all based on the 2008 Prevalence rate of 5.3%
TUBERCULOSIS
I.
In 2009, 72% of tuberculosis cases were cured under directly observed treatment short
course while 82% in 2011
II.
Information from TBL Unit quterly Statistics. In 2009, 28% TB Case Detection Rate
under directly observed treatment short course with 49% in 2011
7
LEPROSY CONRTOL - There are 988 PHC Clinic even plans are on the way to add more
195 of which run M.D.T Clinic. The state has 15 DOTS centres.
MALARIA
Malaria is one of the leading causes of morbidity and mortality in Kogi State. Records show that
between 2007 – 2008 a total of 96,505 cases of Malaria were reported. Under - 5 children
account for 60% of the cases reported and this amounted to 45,723 cases.
I.
Malaria incidence among under-5 children was 2.7% in 2009 it decrease to 2.4% in
2011.
II.
2.0% of women with pregnancy within the last 2 years received intermittent preventive
treatment for malaria in 2009 while 3.0% received IPT in 2011
III.
18% of under- 5 children sleeping under ITN in the previous night.
IV.
54% Proportion of children under 5 with fever who are treated with appropriate antimalarial drugs
2.3 Progress on Systems Domain
2.3.1 Governance
I.
In 2009 9.6% of annual non-personnel budget was executed by the state the figure
decrease to 1.46%
II.
SMOH developed health watch only every 3 years, the most recent edition was 2008 2011 health bulleting.
Standard mechanism is available in the state for grading and accreditation of private health
facilities. State Council for Health is an annual event, the last was 2011. Coordination between
SMOH and MLGA is weak, evidence of neglect of most PHC facilities, it is hope that Bill for the
establishment of Kogi State Primary Health Care Development Agency KSPHCDA will be pass
into law.
The inspectorate unit of the directorate of medical service and training of ministry health in
charged under edict 15 of 1995 with registration, inspection and monitoring of private health
providers in kogi state, towards ensuring minimum acceptable standard of practice of private
health care providers. Services rendered by the unit include;
1. Ensuring that all private clinics, hospital are duly registered.
8
2. Ensuring private health providers comply with minimum standard of practice by adhering
to down rule and regulations.
3.
Ensuring involvement of private health care providers on current trend on health
practice by continuous medical education.
4. Ensuring regular health providers and facility to reduce unethical practice.
5. Ensuring that private health provider co-operate with relevant institution foe collection of
health data for proper health planning and evaluation.
2.3.2 Service Delivery
I.
In 2009 and 2011, 80% and 83% of the wards had a functional health facility providing
minimum health care package. SMOH identified five minimum healthcare package of
health interventions this include MCH, HIV/AIDS, TB, (ATM), Nutrition, Immunization and
environmental sanitation.
According to Deputy Director of PHC in SMOH, The interventions are offered as part of the
PHC program at the LGA level have been designed to reach the unreached, migrant
populations and hard to reach areas are addressed by outreach services thus increasing access
to health care services. The vulnerable groups, such as, children, pregnant women, elderly and
the poor are given increased access and preference whenever services are to be delivered to
the general population. For example, immunizations are given to eligible children free of charge,
Long Lasting Insecticide Treated nets are given to pregnant women and mothers of children
under five years old free of charge. Quality of care has been improved by an increase in the
frequency of supervision, monitoring as well as development of relevant tools which can track
quality in relation to defined standards. Demand for health care has been increased with
sustained health education as well as improved community awareness using various methods
which include community dialogue and various media such as the radio and television where
available.
2.3.3 Human Resources for Health
I.
80% of wards have appropriate HRH complement as per service delivery norm in urban
area while 20% of the ward in rural area had appropriate HRH complement).
II.
Proportion of Health Professionals per population.
 Doctor population ration 1:38092,
9
 Nurses Population ration is 1:84,975,
 Pharmacist population ration is 1:132,562
 Lab Scientist Population Ratio 1:144,089
Kogi State has attained the age of 19 years. The dearth of skilled manpower in the State
remains a major challenge. The middle manpower requirement at the Primary Health Care level
are available in the labour market, but lack of employment opportunities for this category of
Health Personnel has hampered effective delivery of PHC delivery services at the LGA level.
Most (80%) of the skilled manpower in the state are concentrated in the urban area specifically
Federal Medical Center Lokoja and Kogi State Specialist Hospital with only 20% in the rural
area. Doctor population ration 1:38092, Nurses Population ration is 1:84,975, Pharmacist
population ration is 1:132,562 while lab scientist population ration is 1:144,089.
S/N
INDICES
1
KOGI STATE POPULATION
2
Under one Population
132,561
3
Under 5 Population
662,803
4
Women of reproductive Age
729,089
5
Area Square Kilometer
28,312.6
6
Doctor Population Ratio
1:38092
8
Nurses Population Ratio
1:84,975
10
Pharmacist Population ratio
1:132,562
12
Lab Scientist Population Ratio
1:144,089
13
Imagining Scientist Population Ratio
14
Pharmacist Technician Population Ratio
3,314,043
1:1,657,022
1:132,562
10
15
Dental Therapist Population Ratio
1:3,143,043
16
Physiotherapist Population Ratio
1:657,0212
17
Dental Technicians ration
1:2,314,043
2.3.4 Healthcare Financing
I.
3.43% of State and LGA budgets allocated to the health sector in 2009.The allocation
was increased to 6.93% in 2011)
II.
2% of state population falling into the bottom 2 quintiles covered by any risk-pooling
mechanisms
III.
Out-of pocket expenditure as a percentage of total health expenditure more than 70%
It has become a common knowledge that public revenue is grossly insufficient to guarantee
sustainable health care financing. The state 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 state is yet to meet the
National/WHO standard. Less than 2% of populations were covered by health insurance
scheme, no risk pooling mechanism in the state. However more than 70% of total health
expenditure is out of pocket.
11
YEAR
KOGI STATE
BUDGET (N)
HEALTH
RECURRENT
HEALTH CAPITAL
EXPND (N)
TOTAL HEALTH
APPROVE VOTE
(RECURRT./CAPITAL
2,369,754,246
PER CAPITAL
TOTAL HEALTH
EXPENDI-
EXPND (N)
2008
69,675,732,665
282,754,246
2,087,000,000
2009
78,699,082,681
285,291,247
2,417,595,114
2010
78,455,332,453
243,029,624
2,650,000,000
2,893,029,624
3.69%
2011
85,457,638,390
483,709, 448
66, 094,012
3,356,000,000
6.93%
2,702,886,361
3.40%
3.43%
Source: Min of Budget & Planning
2.3.5 Health Management Information System
I.
95% of complete data were submitted only 40% are timely and many were not validated.
No significant change in record of data for 2009 and 2011.
II.
Percentage of disease surveillance reports that are submitted timely was 20% in 2009
and 40% in 2011. However, 80% of completed timely IDSR data were submitted to PHC
department.
III.
45 Percentage of State plans and strategies are based on routine HMIS data to improve
coverage and quality of high impact interventions
Health Management Information systems (HMIS) is one of the Units under the Department of
Planning Research and Statistics (PRS) that was established in the year 2000 with three (3)
staff. The Unit has a Desk officer at the state and in each Local Government Area of the state.
Currently the HMIS office has only three (3) Staff with the Desk officer has the Head of the unit.
Between 2007 till date the unit achievement include;- Procurement of 25Nos ICT materials to
State Ministry of Health H/Q and the 21 LGAs, Quarterly Health Data Consultative Committee
meeting, Training and re-training on the use of the NHMIS forms at State Ministry of Health
H/Q and the 21 LGAs and training of the HMIS officers\ programme officers on the use of the
DHIS software.
Data from all PHC activities are collected and collated by the M&E offices in the various LGAs
for onward transmission to the state M/E officers for analysis and interpretation before it is
forwarded to the policy makers for necessary action. Provision for feedback on M&E information
is poor at all level of health care system. Poor or incomplete data for LGA may be due to the
fact that most of LGA M&E officers have either been transferred or retired and replaced with
12
new ones with little or no knowledge of the work hence the need for training and retraining of the
officer to ensure effective report of PHC activities in the state.
Major challenges on HMIS /M&E are inadequate office accommodation, no logistic for
monitoring and supervision for validation of data from the LGAs, non-release of state budget for
the unit. Poor coordination of IDSR, M&E and HMIS activities in SMOH, for example
Epidemiology unit also deals with collection, collation and analysis of data from PHC activities in
the state. Finally, poor and inadequate quality data from the LGAs may be due to lack of skilled
personnel.
2.3.6 Community Ownership and Participation
I.
As at 2011, 83% of PHC facilities has a village development committee, however, not
more than 15% of this facilities mostly midwife service scheme (MSS facilities) had
active health management committees (at least 4 meetings per year) that include
community representatives
II.
there is evidence of involvement of civil society organizations’ in the development,
monitoring and review of MTSS
Public primary health care facilities in the state are about 80% health posts since 2009 till date,
a substantial proportion of the facilities are in a state of poor repair. Given the relative shortage
of alternative sources of care, health posts necessarily meet a much wider range of health care
needs of the population they serve. Primary health care facilities had a mean of 4.0 staff per
facility; with 90% of the MSS facilities has functional ward development committees. The
chances that other PHC facility has a village development committee is 83%, however, not more
than 15% of this facilities has active health management committee (at least 4 meetings per
year that include committee representative). Community participation is concentrated in the
running of health posts and dispensaries.
To strengthen and sustained community participation in health, SMOH organized various
programs such as routine immunization have as a part of their implementation strategies, the
reactivation of the village and ward development committees in the various LGAs. The formation
of community based organizations is also highly encouraged as these organizations are
involved in the planning and implementation of programs in their communities. Participatory
planning is also a vital strategy being used to improve the participation of the communities in
their health care.
13
SMoH used and adopted National MTSS guidelines for the activities other civil society
organization are actively involved in the development, but not strongly involvement in
implementation monitoring and review of MTSS.
2.3.7 Partnership for Health
I.
No new PPP initiatives in the state, there is a plan on private laboratory and SMOH
II.
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.
III.
There are few development partners in the State, the most active include MSH, Sight
Safer, ICAP and SFH.
PHC Department coordinate monthly meeting of partners as it relate to disease conditions
HIIV,TB, Malaria and immunization, however, there is duplication in activities of carried out by
the partners. Prominent of the partners is health systems project (HSDP) declared effect on 8th
Sept 2003 with an initial credit facility of $5m. Project re-structuring brought an additional sum of
$2m, thereby bringing the facility to a total sum of $7m. In a bid to ensure that all the on-going
projects where completed, Kogi State HSDP-II was considered for additional financing to the
sum of $3m on the 14th September, 2009 project still on.
A wide range of development partners are involved in the implementation of PHC programs
across the State. The Sate Strategic Health Development Plan is been implemented with the full
participation and involvement of partners to ensure key strategies are planned for and
actualized.
2.3.8 Research for Health
I.
0.05% of health budget spent on health research and evaluation. Twenty million Naira
was budgeted in 2009, while 5 million Naira was budgeted in 2011; however, HSDP
funded five 5 researches such as health facility assessment, rate of utilization of health
14
services, medical and infrastructure and Geographical information system (GIS) not
more than 0.05% budget health for research.
II.
Five different research One Proportion of research and evaluation studies undertaken on
identified critical areas in the SSHDP framework.
With support from HSDP fund. Five 5 researches such as health facility assessment,
rate of utilization of health services, medical and infrastructure and Geographical
information system
3) See annex 4 for detail challenges and opportunities observed in the field
assessment.
3. 1 CHALLENGES
While noting progress recorded in various dimensions across the system-process and
performance domains, the JAR process also highlighted key challenges that need to be
addressed:

Major challenges is launching of SSHDP which is still awaiting executive
Governor Approval.

Weak and/or non-existence of integrated supportive supervision within the health
sector.

Lack of monthly supervision by LGA to PHC facilities and poor monitoring and
validation of data received from LGA

Budget are made and approved but poor release of fund is a major bottleneck on
implementation of programme activities.

No Portable water supply in most of the health facilities especially attenegoma in
Idah cluster Otta in Ibaji. Poor supply of drug by the LGA, in Ibaji Local
Government has not paid the Midwives Services Scheme Midwives for 8 Months
and CHEW 1 year. Dekina LGA also owing Midwives & CHEW 7 Months salary.
No access road to Otta and Atenegoma BH facilities in Ibaji and Idah
respectively.

Lack of security guards, Attendants, Lab technician in all the MSS facilities

The structure of the facility in Ikuehi, IrokovI and Okaito is inadequate.

In all the Model Primary Health Care (MPHC) visited, there is acute shortage of
essential staff to function adequately thou the facilities are already handed over
to the LGAs.
15

There is no single Ambulance in the model primary health care MPHC visited.

There are no radiology services in the specialist hospital and no laboratory
service in some of the PHC facilities.
3.2 Opportunities
Notwithstanding the challenges, opportunities existing within the system include the following,
not listed in order of importance:
 Kogi State Primary Health Care Development Agency (KSPHCDA) bill awaiting accent
of the Executive Governor will provide opportunities for better coordination of all PHC
facilities between MLGA and SMOH in stewardship role on health.
 Ongoing CBHIS in some part of the state (Isanlu) and other community financing
schemes for informal sector will reduce the high out-of-pocket-expenditure for health
 Harnessing the platform integration of WHO funded immunization programme and MSS
program funded by NPHCDA with State and LGA MNCH will improve maternal and child
health indicators. And lesson will improve sustainability of PHC facility by WDC.
 The MDG/NHIS Maternal and Child project, as well as Community based health
insurance scheme (CBHIS) in Isanlu LGA and environment, will provide platforms to
pursue financial protection of vulnerable populations towards ensuring access to quality
and affordable health care services;
 The Midwives Services Scheme and the CHEW recruitment will increase the pool of
health workers to improve on maternal, newborn and child health outcomes;
 Regular State Council of Health meeting and active WDC of some facilities should be
enhance to other PHC facilities in the state
 Officers at the PHC facilities who are expected to be present were on duty and
dedicated to their function at the time of visit. Provision and availability of mobile phone
will facilitate communication in emergency situation.
 Some of the good practices observed include clean environment in almost all the PHC,
in Okehi, Kabba/Bunu Local government, the midwives initiated drug revolving in their
facilities which improve client flow. A befiting accommodation was given to Midwives in
16
Idah Local Government when their former accommodation was gulted by five out break
in Dec, 2011.
4) WAY FORWARD
Concluding the processes for the 2011 JAR, the under listed way forward are proffered to guide
implementation of the SSHDP in subsequent years towards achieving the measurable results
enumerated in the National Results Matrix, inclusive of the MDG targets.
Leadership and Governance
•
Honorable commissioner should facilitate the launching of SSHDP
•
Governor should sign into law SPHCDA Bill
•
Establishment of mechanism for SSHDP M&E
•
Established State JAR Committee should be sustained
•
Coordinating Partners Committee set up in Department of planning research and
Statistics.
HMIS
•
Validation of Data Submitted
•
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
17
•
Collaborate with Private group e.g on Lab
Services
•
WMHCP
•
One Ambulance for each LGA
•
Work Plan of Dev. Partners streamline to avoid duplication (MSH or other partners to
lead)
•
More orientation on the use of Ambulance for emergency
•
IDSR and HMIS data coordination
PRIORITIES FOR NEXT YEAR
Informed by the findings of the 2011 JAR, the under-listed immediate next steps are proposed:
1. Pursue the launching of SSHDP
2. Pursue passage of the Kogi State primary health care Development Agency bill
3. Urgent actions to be put in place to monitor the 2012 operational plans through the
NHMIS system at all levels
4. Streamline funding for the health sector in line with 2012 operational plans;
5. Align health coordination mechanisms to 2012 operational plans;
18
Annex
1. List of persons interviewed
2. List of Joint Annual Review Team Members
List of persons Interview
S/NO
NAMES
ORGANISATION
GSM NO
1
E.E. Idachaba
DPRS
08032336422
2
Ayo Mebanidu
DDPRS
08074526389
3
Mr. Folayan J.I
NPHCDA
08035604769
4
Iborida J.
Asst. DPRS sub
health account
SMOH
07030637349
5
Aiyedogbon Johnson
PRS SMOH
08038321468
6
Mrs Egbunu Stella
HMIS
08036766700
7
S.A. Adaji
PM HSDP SMOH
08065773483
8
Adams Atakoma
DRS SHIS SMOH
08032149332
9
Mrs Comfort O.Abu
HIV PO SMOH
08033927960
10
Mrs. D. J. Amdife
Coord SMOH
08035904257
11
Dr. J.F. Olorunfemi
DPHC SMOH
08069599797
12
Pharm F.M.B. Salihu
Dir. Pharmacy
SMOH
07035454565
13
Mr. E.Y. Babalola
Dir. Nursing SMOH
08053525964
14
Dr. U.C. Ejeh
Dir. Medical
Services and
Training SMOH
08067078392
15
Dr. F. C.Balogun
DDPHC State
Epidemiologist
SMOH
08055774086
19
16
Mr. S.B. Amidu
Manger NPI SMOH
08035990927
17
Mrs. Elizabeth Momodu
Family Planning
coordinator SMOH
08036321733
18
Bello Joseph
MB&P
08036169487
19
Dr. P.H.O. Amodu
CMD, KSSH
08033143571
20
B.U. Onojah
KSSH
08036213753
21
Dr. B.F. Ehalaiye
KSSH
07068185798
22
Nurudeen L.R
NPHCDA
08035211923
23
D.A. Ageni
TBL PO SMOH
08164506072
24
M.Tutu
Dir. Admin and
Finance SMOH
08036687861
25
V.E. Obafemi
SMOH
07058590566
26
S.Y. Angulu
Eye Specialist
SHOM
08036004389
27
Dr. AkpU Murphy
MSH
08077099602
28
Yunusa Momoh
Logistic Officer
MOH
08036158942
Annex 1 Agenda
2010-2015 KOGI STATE STRATEGIC HEALTH DEVELOPMENT PLAN - JOINT ANNUAL REVIEW OF
PROGRESS IN 2011
- ORIENTATION PROGRAMME FOR MINISTRY OF HEALTH -AND OTHER
PARTICIPANTS
THURSDAY 8TH MARCH 2012
8 -9am
Registration
Registration
Sign-in sheet
9am – 9.10am
Opening Prayer
* Welcome & introductions
Participants
Participants know each
other
20
9.10-9:15am
* Overview &
Purpose of Meeting/JAR
DHPRS
Objective
Participants are clear
about Workshop
objectives
.
9:15-9:30am
9:30-10am
Remarks
Hon. Comm
* Introduction to the
Methodology
Consultant
*Introduction to the Tools
Consultant
Dr Saka, DHPRS
Dr Saka, DHPRS
10:30- 11am
Administrative
Arrangements
11:00am
Desk Review
Secretariat
Using PPT presentation
to present the 2011
JAR Methodology
Participants will be
familiar with the Tools
Presentation of
Timelines
Annex 1;- ATTENDANCE LIST FOR JOINT ANNUAL REVIEW MEETING
S/NO
NAMES
ORGANISATION
GSM NO
1
E.E. Idachaba
DPRS
08032336422
2
Ayo Mebanidu
DDPRS
08074526389
3
Mr. Folayan J.I
NPHCDA
08035604769
4
Iborida J.
Asst. DPRS sub health account
07030637349
5
Aiyedogbon Johnson
PRS SMOH
08038321468
6
Mrs Egbunu Stella
HMIS
08036766700
7
S.A. Adaji
PM HSDP SMOH
08065773483
8
Adams Atakoma
DRS SHIS SMOH
08032149332
9
Mrs Comfort O.Abu
HIV PO SMOH
08033927960
21
10
Mrs. D. J. Amdife
Coord SMOH
08035904257
11
Dr. J.F. Olorunfemi
DPHC SMOH
08069599797
12
Pharm F.M.B. Salihu
Dir. Pharmacy SMOH
07035454565
13
Mr. E.Y. Babalola
Dir. Nursing SMOH
08053525964
14
Dr. U.C. Ejeh
Dir. Medical Services and
Training SMOH
08067078392
15
Dr. F. C.Balogun
DDPHC State Epidemiologist
08055774086
16
Mr. S.B. Amidu
Manger NPI SMOH
08035990927
17
Mrs. Elizabeth Momodu
Family Planning coordinator
08036321733
18
Bello Joseph
MB&P
08036169487
19
Dr. P.H.O. Amodu
CMD, KSSH
08033143571
20
B.U. Onojah
KSSH
08036213753
21
Dr. B.F. Ehalaiye
KSSH
07068185798
22
Nurudeen L.R
NPHCDA
08035211923
23
D.A. Ageni
TBL PO SMOH
08164506072
24
M.Tutu
Dir. Admin and Finance SMOH
08036687861
25
V.E. Obafemi
SMOH
07058590566
26
S.Y. Angulu
Eye Specialist SHOM
08036004389
27
Dr. AkpU Murphy
MSH
08077099602
28
Yunusa Momoh
Logistic Officer MOH
08036158942
22
REPORT ON 2010 - 2015 KOGI STATE STRATEGIC HEALTH DEVELOPMENT PLAN: JOINT
ANNUAL REVIEW OF PROGRESS 2011 MEETING HELD ON 8TH MARCH 2012 AT THE
MAIN CONFERENCE HALL OF MINISTRY OF HEALTH.
The meeting commenced by 10.00am with an opening prayer. Participants were 33 comprising
of CMDs KSSH, FMC all Directors, and programme Coordinators of Ministry of Health with 3
Development Partner. There was general introduction of participants
The Permanent Secretary who represented the Hon. Commissioner, pointed out that FMOH is
interested in knowing how Kogi State is fearing in her Health Care delivery and Implementation
of the Strategic Health Development Plan. He re affirm that Kogi State Government would
continue to pay her Counterpart Cash Contribution to all the Development Partners.
The Director Health Planning Research and Statistics mentioned the objectives and focus of
the Joint Annual Review of progress 2011 of the State Strategic Health Development Plan;
through the eight (8) thematic domains .
The consultant from FMOH appreciated the response of participants to the programme and
pointed out that the outcome would give a baseline for the state Government on implementation
on health programmes. He further mentioned the methodology of assessment which include;
Desk review, Joint field assessment, Stakeholders meeting and Validation meeting.
In the Interactive session it was observed that the Strategic Health Development Plan booklet
had not being officially launched in the State. The Consultant call for a strong advocacy visit to
the Governor for the launch. In their contributions the representative of Dev elopement Partners
reacted viz: UNICEF: Encourage programme officers not to be economical about the truth,
report issues as they are. WHO: Call for strong advocacy visit to the Government and all
stakeholders. MSH: Government should coordinate the Development Partners not to work
independently but as a team to achieve same goal. He further call for self evaluation of all the
partakers of Health Service Delivery. The meeting ended by 12.00 noon with a closing prayer.
Johnson Aiyedogbon
HRH Desk Officer
23
Annex 2
2011 JOINT ANNUAL REVIEW KOGI STATE people Interviewed in the field
Health facility visited
People met
Designation
Dekina LGA Urban
1. Audu Yahaya
2. Tijani Ibrahim
3. Saliu Mohammed
Dr. Simon Akogun
L.I.O Dekina LGA
1. DRH Ayingba Urban
Ibrahim A
HOD Health
Chief Protocol Officer
CMD
CNO
2. MCH Ayingba urban
O/In charge
Lab Scientist
Pharmacy Technical
Midwives
Ankpa LGA Urban
Ameh Enajoh Simon
HOD PHC
PHC Ankpa Urban
Alamadu Mohammed
Matron
A
Lokoja LGA
M.M. Onuche
Director PHC
Mphc Felele
Felix Inubaraiye
CCHO
CMO
Lokoja SH
Dr. Ojo J.A
Head Clinic services
CHC Ofugo
Akile Nancy
Focal person
PHC Ojoku
Bello Sarah
Midwife
PHC Ogodo
Fatimehin Olusola
Midwife
Lokoja FMC
ANKPA LGA
OKEHI LGA
MCH Obeira
Midwife
24
MCH Obangede
Atti Jane
Midwife
PHC Okaito
Olagboye & Hanah
Midwife
BHC/rokovi
Elegbe Funmilayo
Midwife
MCH Dekina
Okosun Success
Focal Person
MPHC Ulaja
Babatunde Beatrice
Midwife
Dekina LGA
MCH Anyigbe
CHC Ayingba
OK
Omale Elizabeth
Kabba Bunu LGA
Midwife
OK
PHC Ayede
Orimola Elizabeth
MSS
Odo Ape
Emily Ekpo
MSS
MCH Egbeda
Ayodele Catherine
MSS
Okene G.H.
Mr. Echichi
CMD
MCH Okene
Grace Ehnsanni
OK
25
Annex 3;- GENERAL FINDINGS –Field Visit Health FACILITIES
GM&EL
Ankpa
Kabba
Okehi
Dekina
GHs
FMC
LKJ
Suitable staff
accommodation
Available
No toilet
Fully
Available
Fully
accommodate
d
Not
available
Not
within
the
hospital
Regular LGA
Allowance/salary
50%(PH
75%(
except 1
MSS in
Okaito 4
months
outstanding
)
80%
100%
For staff
100%
100%
100%
Availabl
e
20%(Not
Available
50%(Not Availabl
adequat e
e
fully
available
C Ofugo
100%(Full
y paid)
- 1 MSS
not paid
PHC
Ogodu
July &
Aug).
Accessible road
to the facilities
100%
80%
Adequate clean
water and light
20%
50%(Wate
r available
but not
clean in 2
facilities
80%(No
water in
Irokovi PHC
No Referred with
Emergency
Obstetric care/05
EOC
EOC
EOC
13
9
18
Availability of
feedback on
referral to the
Gen. Hospital
25%
0l
0
Conduct
outreach services
100%
100%
100%
10
25
75%
none
NA
100%
100%
Not
done
26
Regular minuted
team meeting
(Facility &
community)
100%
100%
100%
100%
20%
Not
availabl
e
Functional
transport for
referral
0
100%
100%
100%
0
Availabl
e
Availability of
standard
register,/ form in
use
100%
100%
100%
75%
100%
Availabl
e
HMIS&M/E
Ankpa
Kabba
Okehi
Dekina
Okene
Lokoja
HMIS form 001
completed last
month
75%
75%
75%
75%
100%
Availabl
e
Send M&E form
to LGA last
month
75%
100%
75%
100%
100%
Not sent
but
availabl
e
Universal
precaution
50
100
100
100
100
Availabl
e
Guideline
followed
Suggest more
than 3
items/prescriptio
n
Facilities have
basic lab.
Equipments
Yes
50
50
100
100
100
Yes
25
0
25
0
Yes
25
Sustainable drug
supply system:
75
75
25
75
0
Yes
Facilities have
essential drugs
75
100
25
75
0
Yes
No – 1HF
27
Ayangba
Facilities keep
adequate record
of drug
utilization
100
50
100
75
0
Yes
Routine
immunization
Ankpa
Kabba
Okehi
Dekina
Okene
Lokoja
Immunization
register up to
date
75
100
100
100
100
Availabl
e
Monitoring chart
showed DPT 3
coverage last
month
0
50
0
100
100
NA
Facility Cold
Chain system
Functional
0
25
25
25
100
NA
Monitoring chart
showed DPT
coverage last
month
0
50
0
100
100
NA
Provide 24 hrs
maternity
services
75
100
100
100
100
Yes
Facility provide
family planning
services
75
100
100
25
100
Yes
Facilities have
basic
commodities for
FP
25
100
75
50
100
Yes
Facilities provide
ANC services
100
100
100
100
100
Yes
MNCH
28
Pregnant women
attending the
facilities routinely
offered IPT
75
100
100
100
Facilities have
long UN in stock
for distribution
0
100
0
0
PMTCT services
provided
75
100
Yes
N
1
00
75
50
50
Yes
1
00
Have vit. A sup..
Cap. In stock
50- none
in Ofugo
& Ogodo
75
0
25
100
Yes
Conduct delivery
bySTAFF trained
on LSS or MLSS
100
100
100
100
100
Yes
Provide BEOC
services
25
100
100
50
0
Yes
Standard
100
treatment
protocol available
and in use for
EOC
100
0
75
0
Yes
PNC&IMNCI
Ankpa
Kabba
Okehi
Dekina
Facility provide
PNC service
75-NO in
ojoku
100
100
100
100
Yes
Facility provide
IMCI
50
100
100
75
100
Yes
Conduct routine
growth
monitoring for
under 5
50
100
100
100
100
Yes
No in
Ofugo &
Ogodo
29
Facility keep upto-date record of
Vit. A
0
100
75
50
100
Yes
Facility provide
Vit.A for children
6 – 59 months
50
100
0
50
100
Yes
Manage sick
child using IMCI
chart booklet
25
100
100
50
0%
NA
Facility provide
HCT service
0
100%
75%
100%
100%
Yes
DOT service
provided at the
facility
50
50
100
50
100
Yes
Display case def.
of epidemic
prone diseases.
100%
75%
75%
100%
100%
Yes
Facility send last
month DSN
report to LGA
100%
100%
75%
100%
100%
N
Facility have an
outbreak
response plan
75-NO in
PHC
Ojokwu
75%
75%
100%
100%
Yes
Community
Participation
Ankpa
Kabba
Okehi
Dekina
Okene
Lokoja
Strong
Community
mobilization &
Information
75%
75%
75%
75%
Yes
Community comanagement
75%
75%
75%
75%
N
DCSR
No in 2
HF
30
Availability of
free MNCH drugs
and services
100%
75%
75%
75%
N
N
A formal
mechanism for
client feedback
100%
100%
100%
100%
Y
Y
Functional WDC
in place
75%
100%
100%
75%
NA
NA
WDC participate
in the
management of
the facilityN
75%
100%
100%
100%
NA
NA
Midwives have
links with WDC
100%
75%
100%
100%
NA
NA
PHC staff
mobilize
communities for
health action
continuously
75%
75%
100%
100%
NA
NA
HUMAN RESOURCE REVIEW
General
Ankpa
Kabba
Okehi
Dekina
GHs
FMC LKJ
Doctor
0
0
0
0
72
85
Community
Health Officer
1
0
0
2
12
0
Record
2
2
0
1
32
37
Issues
Assistant
31
Nurses
0
5
6
2
-372
-232
Midwives
(MSS)
10
16
14
16
-
-
Nurse
0
16
6
1
-
-
CHEWS
9
38
2
19
16
0
JCHEWS
2
12
1
9
Pharmacy
Technician
1
1
0
0
8
0
Laboratory
2
2
1
1
61
38
Environment
0
Health Officers
0
0
0
2
3
Health
1
17
0
163
Cleaners
6
1
4
Security staff
4 (none at
0
1
23
-
Outsourced
2 – Misopro
stol
MP – 1
LSS
LSS
LSS
None
Nil
NIL
NIL
NIL
midwives
0
staff
184
Assistant
9
Okenyi)
Type of training
received and
number of staff
trained
6 (LSS/MCI)
6 not trained
on LSS/IMCI
LSS – 4
2 on TB, 1
misprestol
No. of
appraisals:
sanctions &
reward given
None
32
ANNEX 4 ATTENDANCE AT THE VALIDATION METING ON JAR REPORT ON 15TH
MARCH 2012 KOGI STATE JOINT ANNUAL PROGRAM REVIEW
S/N
NAMES
ORGANIZATION
GSM NO
1
Dr S.O. Ihinmikaye
SMOH
08063564191
2
Buari S.B
UNICEF
08133622448
3
Phar (Mrs.) F.M.B. Salihu
SMOH
07035454565
4
Lanre Adeniran
WHO
08033156100
5
Mrs. B.I. Ameh
M.O.H.
08036302971
6
E.Y. Babalola
SMOH
0853525964
7
S.B. Amedi
SMOH
08035990927
8
Salihu .Y. Angulu
SMOH
08036004389
9
D.J. Amdife
SMOH
08035904257
10
J.I. Folayan
NPHCDA
08035604769
11
J.Y. Ameh
HMB
08065335120
12
Mrs. O.V. Alepa
HMB
08036982268
13
DR W.A.S. Omale
HMB
08039305280
14
Dr. Idoko F.O
KSSH
08035675734
15
Mrs. E. Mamodu
SMOH
08036321733
16
Mrs. Y.M. Adedajiri
SMOH
08069618926
17
Comr. Funke Kanjuri
NANNM
08035876216
18
M.J. Bello
FMOH
08023571210
19
Adamu Isaiah
FMOH
08027407946
20
Doreas Merryi
FMOH
08167474594
21
Johnson Aiyesogbon
MOH
08038321468
22
George Suleiman
MOH
0806717666
33
23
Pharm. J.B. Olorunfemi
HMB
08036205889
24
DR Olorunfemi J.F
SMOH
08069599797
25
Iborida J.A
SMOH
07030637349
26
Obayomi Ayodele
(Lokoja L.G.A)
07081300272
27
DR Ochimarva A.S
HMB, LKJ
08059507781
28
Dr Ejil U.C
MOH
08007078392
29
Dr F.C. Balogun
SMOH
07030123011
30
Dr Akpu Murphy
MSH
08077099602
31
Christian Amodu
SMOH
08030417449
32
Comr. Abu
SMOH, LKJ
08033927960
33
Dr, Mrs., Dorcos .S. Onuarinya
Hon. Comm.SMOH
08038224168
34
E.E. Dachabo
SMOH
08032336422
List of Joint Annual Review Team
1.
2.
3.
4.
5.
6.
7.
8.
Dr Saka Mohammed Jjimoh Consultants
Mr J,J Afolayan NPHCDA
M.J Bello FMOH
Adamu Isaiah FMOH
Doreas Merryi FMOH
Alhaji Ahmed TIjan Permanent Secretary SMOH
Dr Olorunfemi J.F Director PHC Kogi State MOH
Dr Idachaba Dir. PRS Kogi State SMOH
34