Adamawa Ahead Of Most States In Primary Health Care Delivery – Belel

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The chairman, Primary Health Care Development Agency (PHCDA), Adamawa State, Dr Abdullahi Dauda Belel, in this interview with Hussaini Hammangabdo, explains the success achieved in transforming the agency for improved health care delivery in the state, new policy adoption towards improved institutional delivery for pregnant women, maternal and child health and many more, for effective health coverage which rates the state first in the region.

What was the idea behind establishing the  PHCDA ?
My appointment started the Primary Health Care Development Agency (PHCDA), before, the agency was managed by four units, the PHC Department, at the various local governments, the Local Government  Service Commission,(LGSC) which handles senior staff welfare, postings and employment  as well as Ministry  for Local Government which has PHC department that coordinates the budget of the local governments
At the Ministry of health also there was directorate of PHC that plans and implement PHC at the state level. Because of the fragmentations of the units, the agency was created to connect all the four units into one agency to improves the coordination and remove bureaucratic bottleneck for improve health service efficiency and  delivery .

How do you tackle challenges of four health units merged to one agency?
When we came on board, we inherited more than 1037 health facilities, they were in state of disrepair and were not functioning, hardly could some of the facilities operate above two hours per day and the environment  was  littered by animal waste.
We carried out a comprehensive assessment of the situation on ground and we find out that access to health services is less than 10 per cent. So even though our facilities were open, people didn’t even go to access the services. We quickly analyzed what the issue was   with a view to addressing them quickly for easy services.
We noticed that the human resources we have was not sufficient and was  over bolted  by the none technical staff that’s to the services  because of the incentives government is providing to the health sector.
That attracted particularly the local government a lot of human resources that was not actually needed .We used staff redistribution policy on strengthening the PHC, focusing on the world health systems since 2011.
We started the policy of focusing on  how we can operate  one facility  per ward in Fufore  local government  area of the state.
As we were planning, we came across  other ways of efficient  service delivery and administration and the outcome base financing  became apparent, we pursued it and we are able to secure  the support of the world in piloting for Nigeria the Out Come Base Approach.
We used Fofure local government for that and moved most of the technical staff to the ward headquarters thereby almost closing the facilities  at the village and  we only concentrate on the health centres  and then we became ambitious and wanted to see if we can operate 24 hours services in seven days a week  through out the year.
With the pilot projects we realised that if the population is more than 8000,it is difficult for the health unit to man it, so with our staff redistribution we just used one technical staff as per 1000 population and therefore every health unit have eight technical staff. Achieving this up till now is still difficult because of the dwindling resources of the government to support salaries and allowances of the staff.
With that pilot project and the reorganisation the health coverage moved from 10 per cent to over 40 per cent in less than a year.
In Mayoinne community, the coverage for institutional delivery for pregnant women to deliver in hospitals instead of home rose from 10 per cent to 100 per cent .That attracted the global attention and people are trooping in and around the world to come to the community and see things for themselves.
That attracted investors to our services as we got support from the World Bank, European Union and also our development partners the WHO and UNICEF, among others.
Strengthening this has be done through a coordinated time frame and we advocated for a single health plan and we supported the Ministry of Health to have these strategic development plan from where we extracted the BSC framework and the PHC plans and we aligned these plan with the national strategic development plan for the same goal with the same resources.
Other ministries like the ministries of Finance, Information, Women Affaris and Water Resource, that are health related, supported us  through looking at our plans and see where they can come in and help us.
For example, communities that are having out break of deaherria is as a results of lack of clean water. Now that there are no medicine in these communities, working with the Ministry of Water Resources has helped us to do the water mapping in Adamawa State, looking after the high risk of communities to be their focus .
That has helped us to reduce the health burden of water related diseases equally, with the support of Ministry of Women Affairs, we identified women and children as actually the most vulnerable, they demand higher needs in health services than men.
Social development is also under the same ministry that is why the ministry is up and doing to sought out some of these social barriers to accessing the services that we are providing.
So with this coordination and the transparency brought up, planning and we recoded absolute coverage in both the quantity an quality of our service which culminated to Fufore local government recording above 80 per cent success.

What is the position PHCDA Per Ward Revitalization in in the state ?
Today, we have 403 health units in 226 wards, some of the wards are very large, we have to split them into units and operate 24 hours services, providing the minimum package recommended by the Federal Government.
I think in the Northern part of Nigeria ,Adamawa State is the only state that has been attested to by the recent concluded  reports on the facilities this was compiled by the Honourable Minister of Health, the state came first in the facilities rate of one PHC per wards revitalisation. We are far ahead of most of the states and we are still strengthening of PHC services delivery in the state.
When we came on board we inherited over 8000 staff, more than 4000 of them are non technical staff, some of the staff could not assigned particular duty, but we redesigned our services package assigning task sharing, though the  health units. We were able to regroup them for those who are technical to observe the non technical staff to work along with them .
Over the years, we are getting attrition as a result of transfers, death ,retirement and what have you. there is  and there is restriction on the employment and as people are retiring, the income of the state is going down so the willingness to employ is not there.

What is the agency doing to clear salary backlogs and strength human resources development for good working synergy ?
When the administration of Governor Umar Jibrilla Bindow came on board  four incredible committees were constituted. The Moris Vonobolki Committee, Egr. Lutu Arin, Paris Club, Bail Out among others, all looking at not only the health workers but all the local governments employees and  salary related issues.
Along that line, the health staff threatened for strike demanding certain issue be addressed immediately. The governor again set up a committee headed by the deputy  governor, Martines Babale and that committee was able to resolve those issues within two months and at the end of the day when he got the bail out another committee headed by chief of staff, Abdulrahaman Abba came up and finalized the understanding of the distribution of the local government workers including the health workers.
The final reports of the committee will be made available to us as the MDS and the health workers will see the strength of staff that have been  approved by the committee as rarified by the Executive Council. As soon as that is done, we would now be able to know what  is our staff strength.
We want to move to the vacancy system if there are still vacancies,  going by the restructuring process. We want to make request to the governor of the state  and the leadership of local government areas   for waiver to fill those vacancies because there is no way health care services can be provided  without the healthcare worker.
Especially with the regular, I believe the backlog  has been reduced to minimum and there is hope that very soon, it  is going to be cleared and the staff motivation has tremendously improved and is geared towards effective and efficient service delivery and we have seen that translated into improvement  in our service coverage in the last few quarters.

What are your agency’s dreams in addressing maternal, child health and disease
In the front line we are looking at maternal and child health as well as addressing issues of disease control and producing general care to the general population.
The next level is we want to fashion out core sharing financial mechanism where people can contribute not only when they are sick but when they are healthy as well.

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