PACFaH@Scale to partner with NILDS to build capacities of Nigerian Legislators as DG says FG will prioritize healthcare funding in 2020 budget-13th September 2019

PACFaH@Scale meeting with Director General-National Institute for Legislative & Democratic Studies

The National Institute of Legislative and Democrat Studies, NILDS, has pledged to consolidate policy reforms started by the former administration of the institute with the Partnership for Advocacy in Child and Family Health at Scale, PACFaH@Scale, as part of the strategic partnership to build consensus around healthcare reforms in Nigeria.

NILDS has been a partner since 2014 when the PACFaH project started before its scaling in 2017.

The Director-General of the institute, Professor Abubakar Suleiman, disclosed this when he received a delegation from the PACFaH@Scale project led by the Senior Technical Advisor, Dr Stanely Ukpai.

The National Institute for Legislative and Democratic Studies (NILDS) is an organ of the National Assembly established by an Act of Parliament. President Goodluck Jonathan signed into law the National Institute for Legislative Studies Act 2011 on March 2nd, 2011 following the passage of the same by the Senate and the House of Representatives The Institute also provides capacity development services to democratic Institutions and governance in Nigeria.

The Director-General said the federal government of Nigeria will prioritize the funding of the health sector in the proposed 2020 budget which will soon be sent to the National Assembly before the end of September. He added that the institute as a premier capacity-building center for legislators at the state, federal and even ECOWAS levels, is open to strategic partnerships that will support policy reforms in Nigeria.

‘As one of the world’s premier academic and research institutions, NILDS supports the sustenance of dynamic and effective Legislature in Nigeria at the Federal, States and Local government levels, and the ECOWAS sub-region in general and we are ready to continue to collaborate with partners like you to consolidate these reforms’ He said.

Professor Suleiman added that collaborations like this have been encouraged as a cardinal objective of the institute to promote critical sectors, especially the health sector.

‘As an agency created to build the capacities of the legislators, we encourage partnerships with non-profit like you and e look forward to expanding this existing relationship for a better 9th national assembly’ He added.

While assuring that NILDS has taken the relationship with non-profits as sacrosanct, he said a Professor of Medicine will soon join the leadership for the institute to take charge of collaborations and relationship such as the dRPC-NILDS partnership.

‘NILDS has engaged a Professor of Medicine to enable us to boost the healthcare delivery, workout partnerships with groups like you, focus on healthcare reforms and create a unit that will concentrate on promoting healthcare delivery as a legislative agenda’ He said.

Under the new reforms, according to him, NILDS will conduct workshops on health reforms for legislators at the national, states and local government levels. A roundtable for the senate and House of Representatives committees on health will also be organized to set in holistic reforms of the sector as a legislative agenda.

‘We are seeking to build a sustainable partnership that will not only concentrate on the National Assembly but will consider creating partnerships with donors with the state assemblies’ He further said

Earlier, Dr Stanley Ukpai said the project is ready to support the institute to implement their work plan as requested.

He disclosed that dRPC, under the first phase of PACFaH, had supported the senate committee on health to travel to South Africa to study legislative processes that led to the appropriation of the 1% consolidated revenue fund into the 2019 budget. A feat he said that, has today, led to the proposal of the fund as a statutory release from 2020.

At the end of the visit, the Director Research of the Institute, Professor Muhammed Ladan revealed the areas of partnership the institute hopes to sign with the PACFaH@Scale project. These are:

  • To focus on healthcare law reviews and reform in the national assembly, senate and committee members of health.
  • To organize a roundtable for the senate and members of the House of Representative health committee.
  • Organize a training workshop for the senate and house committee legislative aides, staffs and clerks on health budget proposals.
  • Update and publication of all dRPC-NILDS health-related bills drafted/analyzed/scrutinized into one single publication for the guidance of the National Assembly and CSOs and others.

Highlight of the visit was the assurance of the DG that a final agreement will be signed with PACFaH@Scale detailing a timeline for the implementation of the partnership.

PAS advocates media campaign for 2020 health sector budget 14th September 2019


Before the advent of the fourth republic in 1999, the budget circle in Nigeria has always been from January to December. However, the sour relationships between the legislature and the executive completely changed the circle to the current unpredictability leading to poor budget performance over the years. This might change as the Federal government of Nigeria disclosed that N9.79 trillion proposed budget for 2020 will be presented to the National Assembly before the end of September 2019 as part of budget implementation performance plans of the government.

This new approach to timely budget proposal comes as an opportunity for the CSOs to re-strategize and re-organize their advocacy approach, and PACFaH@Scale took the initiative to roll up a one-month media campaign to advocate for appropriate budget for the health sector in the 2020 budget.

The hashtag of the campaign is #CSOvision42020healthbudget

PACFaH@Scale Advocates shortly after the Budget Advocacy Training

 Objectives of the Campaign

The media campaign is a comprehensive and strategic plan that aims to saturate the media space in Nigeria to raise the discourse around budget advocacy as a national event.

The objectives of the campaign are as follows:

  • To create awareness about the performance of the 2019 health budget
  • To advocate policy makers and legislators why the 2020 health budget should include critical provisions for FP, CKD, RI and PHCUOR
  • To mobilize support for appropriate health budget allocation in the 2020 proposed budget


Stages of the Campaign

To succeed with this media campaign, 4 components were designed namely

  • Identification of confident advocates from PAS 26 advocacy subgrantee
  • Training the Advocates on budget advocacy, budget processes and budget monitoring and evaluation
  • Media appearances, interview skills and public speech
  • Identification of strategic and appropriate media stations


Dr Afolabi Bajuem, Technical Adviser, DG, Nigeria’s Budget Office during his presentation


The Training

A 1-day training on Budget Advocacy for PACFaH@Scale Advocates was organized on Saturday 14th September 2019 at the PAS training centre in Abuja for 10 Advocates from across the 8 PAS focal states.

Objectives of the Training

  • To improve the capacities of PAS Advocates on Budget Advocacy
  • To enhance the skills of the PAS Advocates on Budget processes, monitoring and evaluation and updates
  • To strengthen the capacities of the PAS Advocates on TV appearances and Media engagement skills

The Advocates were exposed to health budget processes, technical terms and the role of NGOs in health budget advocacy, monitoring and evaluation by Dr Afolabi Bajume, a Technical Adviser to the Director-General of Nigeria Budget Office.

They were also trained on technical mastery of data and the power of analysis by Mr Wale Micaah, CEO, StatiSense, Lagos.  A News Manager with the Nigerian Television Authority, NTA, Mrs Rashidat Mustapha took them through on PAS Advocates as communicators, leaders and data-informed confident Speakers in front of the media.

There were group works, group presentations, roles play and intermittent questions and answers to ensure all the Advocates are well prepared for the campaign.


 A cross-section of the Advocates during a group work


The Media Mix

The Advocates will engage a total of 24 media organizations, including TV stations, local and international Radio stations, Newspapers, Online newspapers and with a robust social media campaign encapsulating the 1-month campaign.

The Messaging Focus

The focus of the Advocates will be to use the data available from the budget office and the 2018 NDHS to buttress their advocacy demands. Facts such as continuing inability of Nigeria to allocate 15% of the budget as agreed in the 2011 Abuja declaration, drastic cut of the FP budget from N1.2bn in 2018 to N300m in 2019, non-release of counterpart funding for routine immunization in 2019 budget, non-release of single kobo for capital expenditure for the health sector in the 2019 budget as at September, increase in under 5 mortality in 2019, etc.


The campaign is a 4 weeks campaign that has already begun with an interview with the BBC Hausa this morning (Sunday 15th at 6 am CAT) and will continue up to the 15 of October 2019.

Thank you

Hassan A Karofi



dRPC builds capacities of PDs on leadership and advocacy communication

Project Directors, working under the partnership for advocacy in child and family health at scale, (PACFaH@Scale), participated in a two -day training workshop held June 14-15 at the dRPC-PAS office in Abuja, to improve their skills in leadership and advocacy communication as part of the ongoing capacity-building initiative for partners in the project. The workshop was designed to increase participants’ skills on how to initiate and sustain advocacy targeted at decision makers in key constituencies – the executive and the legislature.

Training Methodology
The workshop was interactive. It employed a variety of methods to build skills. This included role plays, group assignments, presentations and discussions in plenary. For example, participants were assigned into three study groups with four thematic activities, namely, a role-play assignment individual reflection activity (memories/knowledge), presentations at group level, and plenary debriefing.

Key Learnings
Participants acknowledged, following an analysis of pre-test and post-test workshop questionnaires and individual feedback, learning how to strategically develop and deliver messages to policy makers. In addition, participants learnt how to use specialized skills and competencies to build, follow-up, review and evaluate advocacy and communication initiatives within the PAS project. The participants also learnt about innovative ways of communicating with advocacy targets, credibility of the information channelled to advocacy targets, importance of brevity and timeliness of messages, how to analyse the advocacy messages, and how to collaborate with the media. A consultant, Malam Umar Kawu who is a leadership management trainer facilitated the workshop.


Expanding Healthcare Access to The Poor and Vulnerable Children in Nigeria Through Creation of Enabling Environment for Policy Change and Public Private Integration-The Case of the PACFAH@Scale Project in Nigeria


Nigeria falls significantly short of the universal health coverage (UHC) targets set by the nation. Nigeria’s public health expenditure is sub-optimal, with out of pocket expenditure at 71.5%[1], a 0.2% decrease from the 2014 WHO Global Health Observatory for Nigeria. The relatively high levels of private out of pocket expenditure, does not reflect improvements in the health systems and the achievement of the goal of UHC. Access in Nigeria to lifesaving drugs for the poor and vulnerable is generally low, with only a proportion afforded adequate coverage. Two of such drugs in focus are Amoxicillin DT and Zinc-LO-ORS described by UNICEF and WHO as effective and cheap for the first line treatment for childhood pneumonia and diarrhoea, respectively.

It is on this premise that the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) project, a social accountability project anchored by the development Research and Projects Centre (dRPC) sought to expand healthcare access to the poor and vulnerable by advocating for the inclusion of the WHO recommended treatment protocols and the subsequent increase in the implementation of the newly adopted policies to end childhood killer disease (Amoxicillin Dispersible Tablet and co-pack Zinc-LO-ORS for Childhood Pneumonia & Diarrhoea respectively) through the Primary Health Care (PHC) system and with community pharmacists (CPs) and patent proprietary medicines vendors (PPMVs) as private sector providers at National level and in Niger, Kaduna and Kano States. The Pharmaceutical Society of Nigeria (PSN), a civil society partner implemented the PACFaH@Scale project as one of the primary sub-grantees of the dRPC from 2014-2017; advocating for the mainstreaming of Amoxicillin DT as first line treatment for childhood Pneumonia and ORS-Zinc (co-pack) as treatment for childhood diarrheal diseases and for increase in the total health funding in Nigeria.


In Nigeria, Pneumonia and Diarrhoea account for 14% and 9% of these preventable deaths amongst under- fives2. Together, these diseases are responsible for at least 23% of U-5 mortality; preventing Nigerian children from growing up to celebrate their fifth birthday. Due to poor access to life-saving drugs, 854,000 of the 7,028,000 annual live-births in Nigeria die before their fifth birthday[2]. Translating to one in every eight Nigerian child[3].

There was an urgent need for the government of Nigeria and other relevant stakeholders to place priority on mainstreaming this management of childhood Pneumonia and Diarrhoea. By addressing these two diseases alone, we would save over 196,000 deaths annually in Nigeria. The bar chart below highlights the pneumonia and diarrhoea profile of under-fives of select North-western States in Nigeria prior to initiation of intervention by the PACFaH@Scale project from the National Demographic Health Survey (NDHS) 2013.

[1] National Health Account 2016

[2] Nigeria National Demographic & Health Survey 2013

[3] Multiple Indicator Cluster Survey 2017


Embracing the heterogeneity of health systems, and adopting holistic strategies that combine public and private schemes will contribute to providing seamless coverage across social groups in Nigeria. Some thematic areas identified where strong PPP holds opportunities included:

  • Leadership and Governance: Health systems depend on the quality of governance arrangements for the achievement of enhanced performance. Health-related PPPs can both target supporting general governance improvements and themselves offer strong governance.
  • Policy and regulation: PPPs are often dependent on policies and regulations thus a regulatory actor has to exist to govern the PPP project.
  • Advocacy: This seeks to keep the above two accountable on commitments. This role will be played by the CSO advocates and champions not just in the third sector but also in the public and private sectors.


PSN, under the PACFaH@Scale project, aimed to hold duty bearers in the executive and the legislative to account on funding and policy commitments as well as reducing administrative and regulatory barriers to child and family health via advocacy. Utilizing the concept of the PACFaH@Scale advocacy cycle in figure 2 below, PSN developed evidenced based advocacy messages, identified advocacy targets and formed media and other civil society organisation coalitions.

Figure 2: The Advocacy Cycle

Figure 3: The PACFaH project theory of Influence

The above advocacy strategies were deployed through evidence generation and dissemination; coalition building; advocacy visits/meetings; policy dialogues; media and CSO coalition capacity building; media dialogues; press-briefings and roundtable discussions on the backdrop of the theory of change and theory of influence in figure 2 above which highlights our intentions on how we aim to achieve results.

Key advocacy messages developed for ending childhood killer diseases:

  • By mainstreaming the approved childhood Pneumonia and Diarrhea policies, the over 196,000 children who die every year in Nigeria from these diseases can be saved; and
  • Implementation of the approved childhood Pneumonia and Diarrhoea policies is critical to ending U-5 mortality in Nigeria.

By advocating for increased implementation of the newly adopted policies to end childhood killer disease (Amoxicillin dispersible tablet and co-pack zinc-LO-ORS for childhood Pneumonia & Diarrhoea respectively) through the PHC system, and with CPs and PPMVs as providers at National and state level, strengthening the National Drug Formulary7 with Amoxicillin DT as first line treatment for childhood Pneumonia and ORS-Zinc as treatment for childhood diarrheal diseases; and by strengthening civil society organisation (CSO) and media coalitions in support of Amoxicillin DTA as first line treatment for childhood Pneumonia and ORS-Zinc as treatment for childhood diarrheal diseases, we can expand healthcare to the under-fives who are represented in the subset of the poor and vulnerable population.

Advocacy targets mapped and identified:

The primary advocacy target(s)-those with direct authority to make decision:

  • National Council on Health;
  • Honourable Minister of Health; and
  • Honorable Commissioners for Health (Lagos, Kaduna and Lagos States).

The secondary advocacy target(s)-those in position to influence the primary advocacy target(s):

  • National Standard Treatment Guideline (NSTG)/Nigeria Essential Medicines List (NEML) review committee;
  • Registrar, Pharmacists Council of Nigeria (PCN);
  • Directors, Family Health; Food & Drugs Services; Health Planning, Research & Statistics, Hospital Services; Nursing Services; Procurement; Budget FMOH; Executive Secretary-NPHCDA-National level;
  • Directors, Pharmaceutical Services; Family Health; Health Planning, Research & Statistics; Hospital Services; Nursing Services; Procurement; Executive Secretaries-SPHCDA; SDMA-State level

The ultimate target group(s) – those in position to influence both the primary & secondary targets;

  • Champions and change agents;
  • Network of civil society organizations-including women, youth groups etc.;
  • Health care service providers;
  • Health care professionals; and
  • Media

The beneficiaries of the advocacy efforts were: children aged (0-5years); Health care professionals; Child and family health decision-makers in government at National and State levels. The policy change when completed will enhance the work of the National and State level officials.

The Pharmaceutical Society of Nigeria (PSN) leveraged on the media and CSO coalitions established during the PACFaH (2014-2017) project. Among the CSOs in this coalition were professional associations, and youth and women groups, which were strategic secondary and ultimate advocacy targets for this project.

A rapid assessment (baseline) of the coalition members’ capacities was conducted prior to engaging them. The media and CSO coalition members who met the baseline assessment criteria then had an orientation program. The media and CSO coalitions were supported to develop and implement advocacy activities around thematic areas and geographies. For sustainability, the media and CSO coalitions were encouraged and supported to inculcate this scope of work into their respective organizations. Situational analysis on childhood pneumonia and diarrhoea were conducted in Kaduna, Kano and Lagos states, also conducted were knowledge, attitude, behaviour and practice to generate evidence of the gaps in the aforementioned states in Nigeria.

In achieving the advocacy goals assigned to PSN during the implementation of the completed PACFaH at Scale (PAS) in 2018, the PSN identified and formed coalitions with other civil society organisations. The Grantees in this group included Society for Family Health/IntegratE; AFP/Pathfinder; Albright Stonebridge Group (ASG); and John Snow Inc./Access Collaborative. The group held series of advocacy strategy review meetings and strategized on engaging relevant stakeholders on key advocacy deliverables.


The PACFaH project supported the Federal Government of Nigeria through PSN to revise the Nigeria National Treatment Guidelines with the inclusion of the WHO recommended treatment protocol for childhood Pneumonia (Amoxicillin Dispersible Tablet) and Diarrhoea (co-pack Zn-Lo-ORS) between 2014 and 2016 after a series of multi-stakeholders engagement and advocacies to government ministries, departments and agencies (MDAs) and professional associations. In July 2017, the PSN-PACFaH project supported the Federal Ministry of Health (FMOH) to launch the revised national treatment guidelines in Abuja, Nigeria[1][2].

FMOH launch of the National Treatment Guidelines July 2017



After the policy launch, further situational analysis and knowledge, attitude, and behaviour assessment by PSN revealed that there was inadequate childhood killer disease (CKD) policy dissemination among key Directorates within the Federal Ministry of Health (FMOH). This has led to non-integration and collaboration in the rolling out of the policy nationwide. Only the Departments of Food & Drug Services and Family Health (Child Health Division) were actively mainstreaming the CKD policy at FMOH slowing the pace of implementation.

To mitigate this challenge, the PSN-PAS project proposed collaboration with the Food & Drug Services and Family Health Departments of FMOH to organize a one-day event where all the Directors and senior officers of ALL the departments in FMOH will be engaged to understand the newly adopted CKD policies as well as the National Essential Medicines List (NEML) and National Standard Treatment Guidelines (NSTG). This increased knowledge, roll-out, support and implementation of not just the CKD policies but other key child and family health policies in the NEML and NSTG.

PSN-PACFaH@Scale worked with other PAS sub-grantees to support the government in disseminating the new national Childhood Killer Disease protocols through a series of zonal meetings. PSN worked with Centre for Communications and Reproductive Health Services (CCRHS-PAS) to disseminate the protocols in the South and North Central Zones on the 24th July 2018 in Lagos state. Key stakeholders included UNICEF and CHAI representatives as well as government bureaucrats drawn from the FMOH, Lagos, Osun, Ogun, Ondo, Oyo, Ekiti, Niger, Kwara, Nasarawa, Benue, FCT, Plateau and Kogi States, in attendance.

PSN-PACFaH@Scale also worked with Aminu Kano Centre for Democratic Studies (AKCDRT-PAS) to disseminate the protocols in the North-West and North-East zones on the 27th July 2018 at Tahir Guest Palace, Kano State. The government officials were drawn from FMOH, Kano, Kaduna, Katsina, Sokoto, Yobe, Borno, Bauchi, Jigawa, Zamfara, Adamawa, and Kebbi States alongside WHO.

In collaboration with Rural African Health Initiative (RAHI-PAS) they disseminated the protocol in the South-South and South-East zones. This strategic activity was conducted on Tuesday 11th September 2018 at Sparklyn Hotel, Port Harcourt, Rivers State. Directors from the Federal Ministry of Health and the chairman/members of the NDF/EDL review committee were present. Other key delegates at the meeting were Directors Medical/Hospital/Pharmaceutical Services from Rivers, Akwa Ibom, Bayelsa, Edo, Enugu, Ebonyi, Abia, Imo, and Anambra State Ministries of Health. Professional Associations-Nigerian Medical Association, Pharmaceutical Council of Nigeria, National Association of Nigerian Nurses and Midwives, National Association Patent Proprietary Medicines Dealers (NAPMED), as well as development partners Clinton Health Access Initiative (CHAI) and media were in attendance.

The government officials from the different geographical zones of Nigeria committed at the end of the event to domesticate and implement (by procuring, and utilizing AMX DT and co-pack Zinc-Lo-ORS) the revised treatment guidelines for the management of Childhood Pneumonia and Diarrhoea in their respective States[1] [2] [3].

[1] &

[2], and


South-East/South-South Zones (Rivers State)

North-West/North-East Zones (Kano State)

South-West/North-Central Zones (Lagos State)

Building on the momentum generated at the dissemination meetings, the PAS-NGOs in Niger, Kano and Kaduna mapped the CSOs and coalitions working on CKD to empower them to monitor the elimination of CKDs over the life of project.

Integrating Public Private Partnership Approach for Breaking Down Barriers for The Expansion of Healthcare Services and The Resulting Impact

There were issues highlighted during the roll-out of the CKD policies at the community level through the critical private health care providers (CPs and PPMVs). While FMOH had approved the use of Amoxicillin DT and co-pack Zn/Lo-ORS at the community level in the NEML and NSTG, the Pharmacists Council of Nigeria (PCN) and NAFDAC who jointly regulate private providers’ practice at the community level, were yet to adopt and revise their guidelines to align with FMOH. Having identified the thematic area Policy and regulation, with an understanding that PPPs are often dependent on policies and regulations thus, a regulatory actor has to exist to govern the PPP. The PSN-PACFaH@Scale conducted advocacies to and workshops with the regulatory body (PCN) on supporting this critical government agency to review the PPMV List with the inclusion of all the recommended policies (CKD inclusive) for child and family health at the community level by PPMVs to align with FMOH. The pre-advocacy status of the PCN PPMV List prevented PPMVs from stocking and selling of these life-saving commodities at the community level, as they faced harassments and detention by the PCN and National Administration for Food and Drugs (NAFDAC). The PSN-PACFaH project from 2015 to 2017 supported to revise the State Essential Medicines List (EML) with the inclusion of the recommended Childhood Killer Diseases (CKD) protocols (Amoxicillin DT for Pneumonia and co-pack Zinc/Lo-ORS for Diarrhoea). The PSN-PACFaH project also supported at State level to develop a draft Costed Implementation Plan (CIP) for CKD and advocated for States to commence procurement of Amoxicillin DT and co-pack Zinc-Lo-ORS. The inclusion of the private sector (CPs and PPMVs) by revising the PPMV list expanded access to these life-saving drugs for hard to reach areas. Through the innovative efforts of the PACFaH@Scale project, there was a policy change. Achieving this policy change to include these live saving drugs into the treatment guidelines was a big win for the project and the communities that had high prevalence of the childhood killer diseases with low or no access to life-saving drugs for treatment, because now the private providers are now able to stock and provide these drugs.

The Impact Of PACFAH@Scale’s Work and The Resulting Policy Change

Figure 4: Prevalence Of Diarrhoea And Acute Respiratory Infections In Under 5’s (National Demographic Health Survey 2018)

The PACFaH@Scale project’s efforts in the updating of the essential medicines list and the patent proprietary medicines lists to include these drugs resulted in the expansion of access to these drugs especially to the hard to reach areas, as the private sector could now stock these drugs. The bar chart above (figure 4) highlights the resulting reductions in prevalence of diarrhoea (NDHS 2108) when compared to (NDHS 2013) figure 1. With Kano state witnessing a 13.9% decrease in prevalence and Kaduna state, a 12.9% decrease amongst other states highlighted in this region.


The burden of many low and middle income countries health systems is that of under resourcing and non integration which leaves many without access to quality basic health services including life-saving drugs. PSN-PACFaH@Scale, through advocacies to policy makers and stakeholders, partnerships with media and civil society organisations and integration of the private sector are changing the narrative having managed to expand the reach of life saving commodities through our work in policy change in a bid to reducing the incidence, prevalence and ultimately the mortalities of under-fives from childhood pneumonia and diarrhoea in Nigeria. The problem of non-inclusion of relevant stakeholders can mar the success of advocacies for policy change at different level. It is our recommendation that for further works on advocating for policy change for healthcare services, it is pertinent to place high priority on mapping of strategic stakeholders and coalitions for reduced resistance by all parties involved and/or affected by the policy change and for the sustainability of the said policy.

Annual Scientific Conference and General Meeting of Epidemiological Society of Nigeria With Sub Theme PHCUOR For Universal Health Coverage


The Primary Health Care under One Roof (PHCUOR) policy was introduced by National Primary Health Care Development Agency (NPHCDA) and partners as a reform agenda to improve Primary Health Care (PHC) implementation at sub-national levels. The policy was adopted at the 54th National Council of Health (NCH) meeting in 2011 and backed by the National Health Act (NHA) of 2014. Under the PHCUOR policy, States are to establish an administratively autonomous and self-accounting PHC board (SPHCB) to coordinate PHC implementation at all levels in every state.

The LGA PHC department is to be transformed into Local Government Health Authority (LGHAs) to manage PHC at sub state levels. All thirty-six States and Fct have established their state PHC board (SPHCB) and are at different levels of functionality.

The PHCUOR policy assesses nine pillars through the scorecards tool namely Human Resource for Health (HRH), Legislation, Repositioning, System Development, Funding Source and structures, Operational Guidelines, Governance and Ownership, Minimum Services Package (MSP) and office set up.

The benefit of the PHCUOR policy is to improve efficiency in services delivery to achieved better health outcomes, promotes equity and increased access to affordable high quality basic health care services to all especially for the poor and vulnerable at the grassroots toward the attainment of universal health coverage (UHC), access to more funding by enhancing eligibility for additional funding such as the Basic Health Care Provision Fund (BHCPF) and other national and international funding for PHC services and lastly it brings about accountability and transparency.

Key elements of the PHCUOR policy implementation are Integration, single management body and decentralized authority, enabling legislation, integrated supportive supervision and effective referral system.

Objective of the sub-theme PHCUOR for universal health coverage at the EPISON conference

  1. To identify major challenges to Primary Health Care under Roof (PHCUOR) policy implementation at national and state levels.
  2. Proffer solutions to the challenges facing PHCUOR implementation
  3. Identify sources of funding for the implementation of PHCUOR policy

Participants: From the Society of Public Health Professional of Nigeria (SPHPN-PAS) 

  1. Dr Tolu Fakeye from FCT Abuja
  2. Professor MC Asuzu from Ibadan Oyo state Kene Terfa from FCT, Abuja
  3. Professor Lu Ogbonnaya from Abakaliki Ebonyi State
  4. Dr S. Ameh from Cross-River States
  5. Professor Obiageli Emelumadu from Anambra State
  6. Dr M.T Solarin from Ogun State
  7. Pharm Mrs Rachel Odesanya from Plateau State
  8. Faith Olajide from Abuja

National Primary Health Care Development Agency (NPHCDA) Abuja

  1. Mr. Adeniyi Ekishola -National Desk officer PHCUOR and Head of Health System Support Division
  2. Mr. Samuel Adelakun -Adesina Head Technical Support Unit
  3. Dr. Daniel Otoh- Head of primary Health Care Revitalization and Consultation- public Health Physician
  4. Mrs Khadija Ishola- Health System Support Division
  5. Mr. Emmanuel Onoshoga- Human Resource for Health Division
  6. Nnenna Ekpo- Human Resource for Health Division

Epidemiological Society of Nigeria (EPISON) Participants

  1. Dr Mathew Ashikeni from Fct, Abuja
  2. Dr Moses Daniel Chingle from Plateau state
  3. Mrs A. Amn Olaniyo from Lagos state
  4. Dr Y. Adamu
  5. Mrs C. Chukwudike
  6. Dr A. Oyemakinde
  7. Professor S.T. Yahaya
  8. Dr. J. Coker
  9. Professor Ekanem Ekanem
  10. Professor Oladele O. kale
  11. Professor S.A. Omilabu

Participants from State Primary Health Care Board (SPHCB)

  1. Dr Yakubu Muhammed FCT Primary Health Care Board
  2. Dr Bashir Mahmud Taraba State Primary Health Care Board
  3. Dr Isah Yahaya Vasta FCT Primary Health Care Board
  4. Dr Thaddeus Asogwa Chijioke Enugu State Primary Health Care Board
  5. Dr Sherriff Yahaya Musa Kano State Primary Health Care Board
  6. Dr. Sabastine Esomonu FCT Primary Health Care Board
  7. Aliyu Zakari Aminu Kaduna State Primary Health Care Board
  8. Dr Abiodun Kemi Odunlami Idiat Lagos state Primary Health Care Board
  9. Dr Ali Balogun Lagos State Primary Health Care Board
  10. Hauwa Kolo Niger State Primary Health Care Board

dRPC-PAS Participants

  1. Mallam Hassan Karofi
  2. Mustapha Kolawale
  3. Sani Ochepo
  4. Kiki Omene

Conference Methodology

  • Presentation on the scoping mission of NPHCDA on PHCUOR activities at the national level by Dr. Tolu Fakeye SPHPN-PAS
  • Panel session made up of resource persons from NPHCDA Abuja and SPHCB participants from Kano, Niger, Taraba, Kaduna, Lagos, Enugu and Fct discussing PHCUOR, this session was chaired by professor Mc Asuzu SPHPN Ibadan Oyo state

Summary of key findings

Major challenges to PHCUOR Implementation at state levels

  • Non establishment of LGHAs by States government
  • Delayed movement of PHC programmes, staff and funds from SMOHs/LGAs to SPHCB/LGHAs
  • Inadequate capacity-building for SPHCBs on PHCUOR Implementation
  • Key requirements for PHCUOR Implementation at state and sub-state levels are not captured in the SPHCB laws
  • Poor funding of SPHCBs by State government and LGAs
  • Poor dissemination of relevant documents and material on PHCUOR
  • Summary of the score by all States and Fct across the nine pillars shows implementation levels of about 43.7%; 38.1%; and 51.4% for scorecard 2,3 and 4 respectively

In conclusion the implementation PHCUOR has proven to be most difficult under four pillars namely Reposition, minimum services package (MSP), Human resource for health (HRH) and sustained funding

Way Forward 1: NPHCDA Should

1: Priorities technical support to SPHCBs to erect solid pillars to house PHCUOR and improve performance on critical pillars like MSP, Repositioning, HRH, and sustainable funding

2: Assist SPHCBs to establish functional LGHAs for all LGAs in State

3: Disseminate the Reviewed PHCUOR Implementation guidelines and others documents/material to guide the SPHCBs team

4: Increase advocacy to state governments to support the SPHCBs to fully implement PHCUOR policy

Way Forward 2: STATE SHOULD

1: Adopt PHCUOR policy and apply guidelines for the implementation at state and LGA levels

2: Seek needed technical support from partners and NPHCDA

3: Establish functional LGHAs

4: Incorporate implementation processes into state health planning

5: Exchange visit with other States for sharing experience and lessons

Dr Tolu Fakeye project Director SPHPN-PAS presenting the findings from the scoping mission on PHCUOR at the national level (NPHCDA)

Prof MC Asuzu chaired of the panelist session on PHCUOR, Mr. Adeniyi Ekishola national Desk officer PHCUOR NPHCDA, Dr OTOH Daniel and Mr. Adesina Samuel all from NPHCDA

Group of participants during the conference

Media Links

DAILY NIGERIAN reports that the conference was supported by the Partnership for Advocacy in Child and Family Health, PACFaH@Scale.

Niger State PAS Partners Meeting with Selected consultants on PAS Project Issue areas; RI, FP, CKD, PHCUOR & Budget


The Niger State PACFaH@ Scale partners under the support from the development and Project Centre, Abuja undertook an assessment visit to some selected facilities (PHCs) in Niger State. The team which comprises of selected members from across the sub-grantee CSOs of the dRPC undertook an assessment visit to identify key issues and updates regarding service delivery, uptake of child and family health issue areas of the project as well as the PHCUOR policy implementation in Niger State

Activities of the Project

Activities of the project revolve around the clusters:

  1. Developing the evidence base for the advocacy visits
  2. Disseminating information briefs to the stakeholders and media and educating them on the advocacy issue
  3. Training Civil Society Organizations in Nigeria and mobilizing them to participate in advocacy visits
  4. Advocacy convening and follow up activities
  5. Building support within government by creating champions within the beaureucracy by working in collaboration with NIPSS
  6. Monitoring, Evaluation and Learning

In the bid to effectively achieve the investment outcome of the project that the development Research and project centre sub-granted some selected CSOs to work in Niger state across the selected issue areas of the project. On this, Centre for communication and Reproductive health services (CCRHS), Socio Economic Research and Development Centre (SERDEC), National association of Nurses and Midwifery Council of Nigeria (NAMMN) and the Federation of Muslim Women Association of Nigeria (FOMWAN) are sub-granted to undertake the implementation of the PAS project in Niger State focusing on Child and family health issue areas of the project.

Niger Pas partners role on the PACFaH@ Scale Project in Niger State aims to achieve the following:

  • Increased budget allocation to FP, RI, CKD and Implementation of PHCUOR
  • Value-added budget tracking for effective and timely release of funds dedicated for FP, RI CKD & PHCUOR
  • Improved leadership commitment and capacity to identify and plan for sustainable sources of funding for FP, RI, CKD and PHCUOR in project timeline and beyond

It is expected that beyond the lifetime of this project, there will be:

  • Increased in government’s commitment to fully fund respective agencies saddled with the responsibilities of the issue areas of the project
  • Adequate budgetary allocation for the four thematic areas
  • Timely release of allocated funds
  • Strengthened partnership of indigenous CSOs around the four thematic areas

Against this background and in the bid to effectively achieve the desired objective of the project that the Niger PAS partners unanimously developed a consolidated work plan to be implemented across the period of May –June 2019. From the work plan and to have the required base line information to support the development of advocacy support materials (Evidence based), the group hired some consultants across the PAS project issue areas including budgets to collate some relevant base line information and specific updates as it relates to RI, FP, CKD and Implementation of PHCUOR policy/PHC Strengthening as well the funding of the issue areas. As part of the mandate of the consultancy. the consultants thereafter had a two hour interactive meetings with Niger State PAS partners comprising of CCRHS-PAS, SERDEC-PAS, NANNM- PAS and FOMWAN-PAS

Objectives of the Meeting

  • To give an update on the level of implementation of the policy and funding of FP, RI, CKD and PHCUOR
  • To generate baseline information and evidence on the issues around child and family health policy implementation and funding to support the advocacy course of the project in Niger State
  • To identify gaps and challenges around policy implementation and funding of child and family health issues in Niger State
  • To strengthen the knowledge and understanding of the PAS partners on the areas of focus of the PAS project
  • To identify bottlenecks and gaps in Child family health programme implementation and funding as well PHCUOR policy implementation and hence deliberate on better strategies to achieving the desired outcomes of the project

The Meeting Targets

  • RI Consultants – Dr. Samuel Jiya (State Immunization Officer)
  • FP Consultants – Mrs Dorcas Talatu Abu (FP Coordinator)
  • Budget Consultants – Mall Abubakar Yanda (Chief Planning Officer Budget)
  • PHCUOR Consultants – Mohammed Katun – (Former Director Planning Research and Statistics SPHCDA)
  • CKD Consultant – Mrs Elizabeth Kalima Jiya – Former Niger State IMCI Coordinator

Niger PAS Partners Team:


  • Aliyu Yabagi Shehu – Project Director CCRHS-PAS
  • Tijanni Abdulkareem
  • Shehu Ahmed Baba – Program Officer CCRHS-PAS
  • Oladele Matthew – M&E Officer CCRHS-PAS
  • Rhishama Auta Sule – Project Accountant CCRHS-PAS


  • Tijani Abdulkareem – Project Director SERDEC PAS
  • Ahmed Abdulsalam – Program Officer SERDEC PAS
  • Mary Jalingo – M&E Officer SERDEC-PAS
  • Aisha Isa Kagara – Project Accountant SERDEC-PAS


  • Haruna Shuaibu Tanko – Project Director NANNM-PAS
  • Ibrahim A. Mairiga – Program Officer NANNM-PAS
  • Abdullahi N. Mohammed – M&E Officer NANNM-PAS
  • Nasiru Sani Aliyu – Project Accountant NANNM-PAS


  • Kulu Abdullahi – Project Director FOMWAN-PAS
  • Gogo D. Abubakar – Program Officer FOMWAN-PAS
  • Ibrahim Aliyu – M&E Officer FOMWAN-PAS
  • Yakubu Adamu – Project Accountant FOMWAN-PAS

The Meeting Deliberations

The interactive forum with the consultants which took place across the span of three (3) days started from Monday the 20th May 2019 to Wednesday the 22nd May 2019. The meeting had two consultants on a schedule to present their findings on plenary for days 1 and 2 and one (1) consultant for day 3. Consultants for Budget and Routine Immunization presented on the 20th May 2019, while consultant for Family Planning and PHCUOR Policy Implementation presented on the 21st May 2019 while the Consultant on CKD presented on the 22nd May 2019. The three days meeting had similar itinery as agenda which is in the following order:

  • Opening Prayers/ Self Introductions
  • Plenary Presentation of Findings by Consultant 1
  • Comments, Question and Answer
  • Plenary Presentation of Findings by Consultant 2
  • Comments Question and Answer
  • Wrap up / Next steps
  • Closing and Departure

The meeting on daily basis across the span of three days commenced at about 9:00am with an opening prayers and self-introductions by all the members present. Presentation of findings by respective consultants with comments, question and answer session following each presentation by the consultants. Across the three days meeting, each consultant was given a maximum of two hours for presentations / comments, question and answer.

Day 01, 20th May 2019

Presentation by Budget Consultants:

The Senior Planning Officer Budget of Niger State Primary Health Care Development Agency – Abubakar Yanda started the day. He made a presentation on the “Update of Health Sector Budget of 2019 with Focus on Child and Family Health in Niger State” The budget consultant presented his findings through a power point projection; his presentation took the participants through the concept of budget, budget circle, health sector budget, update / break down of child and family health approved budget of 2018/2019 as well as budget tracking.

His presentation which in the first phase was on concept and component of budget started from the definition of budget, revenue, expenditures and its other components as well as other budget preparation components. Definitions of terms related to budget as given by the consultant are as follows

Budget as an annual financial and economic plan that serves as a vehicle for the mobilization, allocation and management of resources; a framework for revenue and expenditure outlays for a period of one year; as well as a list of planned Expense and Revenue: it is therefore a plan which sets out the programmes of projected government revenue and expenditure geared towards achieving policy targets.

  • Revenue: is the flow of money accruing to an individual, firm or an economy over some period of time. It may come in terms of gift (Aids & Grants), cash or kind. In order words, Revenue is flow of wealth accruing to an individual, firm or
  • Expenditure: refers to expenses incurred by individual, firms or Expenditure incurred by the government is known as public expenditure. This type of public expenditure in Nigeria deals with both expenditures of Government at Federal, State and Local Government levels
  • Recurrent Expenditure: is the Government expenditure on the consumption of goods and services, i.e immediate
  • Capital Expenditure: is the Government expenditure intended to create future benefits such as expenditure on the     provision of Infrastructure, Research and other developmental projects. It can be referred to investment of goods and
  • Resource Projection: it is the estimation of the income (revenue) that are likely to come to the State in the coming year. The trend of past inflow (receipt) serves as the basis for the projection of revenue for the coming year.
  • Call Circular: it is a letter containing budget guidelines and instructions accompanied by formats usually issued out to MDAs by the Planning
  • Bi-lateral Discussions which he said referred to MDAs reporting to the planning commission on schedule for discussion in order to identify and agree on projects/programmes to be captured in the Budget in line with the government policies and priorities in consideration with the available

The consultant further took the partners through the reason for budgeting, the budget process of Niger State and budget preparation as well budget implementation process.

The Budget process of Niger State as given by the consultant are:

  • Recurrent expenditure: (By Ministry of finance)
    • e-salary
    • Monthly releases of over head to MDAs
  • Capital expenditure:
    • Issuance of budget clearance certificate (in principle)
    • Obtaining approval
    • Obtaining Certificate of No Objection for PPB
    • Issuance of final budget clearance (clearance for release of funds)

He further talked on some budget control processes which involves carrying out of Budget performance analysis on quarterly bases, Monitoring of capital projects, Presentation of Monitoring and Budget performance reports to the Executive Council for possible corrective measures, Periodic discussions between the State House of Assembly and implementing MDAs on budget performance (Oversight functions of the SHoA), Auditing by the office of the State Auditor General. The consultant capped up the first phase of his presentation by relaying to the group, challenges around budget allocation, approvals and releases in Niger State and some recommendations for intervention by the PAS team

The second phase of the presentation by the budget consultant took the participants through the breakdown of of 2018 / 2019 budget allocations, approved and releases for SPHCDA and that of Child and Family Health Issue areas (FP, RI & CKD); see attached documents for details. From the budget breakdown given, it was observed that from 2018 to 2019, allocations are made for FP, RI & CKD with approvals but are not always backed up by releases. Even the SPHCDA suffers the set back of inadequate allocations and releases; that child and family health survives at the mercy of support from SoML and partners working in Niger State.

The third phase of the presentation by budget consultant took the participants through budget tracking process guided with a draft copy of budget tracking tool. The sampled tracking tools have two parts with first part on Health sector budget and the second part on Routine Immunization. The indicators across are; % allocations to health compared to State total budget, % recurrent and expenditures compared to state health total as well as RI budget tracing tool focusing on Budget Allocation, Expenditure and Accountability and Transparency as it relates to RI.

Challenges Around Budget

  • The resources available to the state to be shared are limited but request from MDAs are unlimited. Because every MDA believe is
  • There is also the problem of generate and consume by some
  • No dedicated budget lines for child and family health issue areas in the state budget
  • Poor commitment by the stakeholders to releases to health programmes
  • Non implementation of the CIPs for child and Family Health Issue areas
  • In adequate envelopes to match the allocations to programmes in the SPHCDA


  • High level advocacy visit to key stakeholders in Niger State on allocations and releases to SPHCDA & child and family health issue areas
  • Dedicated budget lines for child and family health issue areas
  • Reduction of donor dependence by the state government
  • Increase commitment of stakeholders to providing sustainable domestic source of funding to child and family health issue areas
  • Release of 15% support from Local Government Income to SPHCDA will go along way to strengthening SPHCDA & its services

Presentation on Routine Immunization

The State Immunization Officer – Dr Samuel Jiya presented on the “Overview of Routine Immunization: Status of RI Funding in Niger State” His presentation which was guided by a point dwells through Situation Analysis of RI, achievements, Challenges, Budget versus Releases. Partners support, opportunities and recommendations.

He started his presentation with a breakdown of statistics of Niger State and went further into current indices as relates to RI and later caped it up with RI funding schemes in Niger State

The summary of some indices given by the consultants as it relates to RI are as scaled out below:

(other details are in the presentation on RI attached)

  • Infant Mortality rate is 70/1,000(MICS,2016)
  • Under 5 mortality is 120/1,000(MICS,2016)
  • Proportion of children fully immunized – only 80% of under -1 children had all basic vaccination for age
  • Niger State has about 1, 543 health facilities and 1,123 (1104- public & 19-private) are offering immunization
  • From immunization checklist, none (0%) of LGAs in the state received funds for its immunization activities and only 28% of private health facilities are providing RI
  • No release of Funds budgeted in state’s budget for Immunization since 2016 to date
  • Out of over 3,628 HTR communities only 578 covered with Immunization activities so far
  • RI has a Costed Implementation Plan in Place to fund RI embedded into the State annual operational plan
  • Potential Funding Sources for RI in Niger State :
    • State budgetary allocation (N116m/4years)
    • Partners’ financial support (N250m annually)
    • Basket funds – BMGF-MoU (N1.293bn)
    • BHCPF (Expecting =N1.5bn)
    • SOML PforR ($1.5m in year-1;
    • USD $1.2m year-2;
    • USD $ 6m year-3

Breakdown of Budget Allocation and Releases for RI in Niger State


Source Budget Release Remarks


AOP 117.3 M



State Budget (2019) 40 M

Approved in Budget


Saving One Million Lives


100M 100 M



RI fixed post & cold chain


Saving One Million Lives (SOML) 160M 160 M

30 solar Direct Drive SDDs Refrigerator procured



Direct Payment to Push vendors

7 WHO Estimated (50M) Estimated (50M)

Capacity Building


  • Non fulfilment of Abuja’s Governors commitment
  • Lack of dedicated budget line for RI in the State Health budget
  • Non release of funds to support RI by Niger State Government
  • Lack of adequate funding for IPDs and RI activities by State and LGAs
  • Non Implementation of CIP for RI in Niger State
  • Difficulty in accessing numerous areas across many of the LGAs (HTR) particularly with the rainy
  • Inadequate health workers to man health facilities in most LGAs
  • Inadequate power supply in the State & LGAs cold stores
  • Inadequate state led supportive supervision. Most of the supportive supervisions in 2018 were done by WHO and partners
  • Inactive State and some LGAs Task force committee


  • Close Funding
  • LGAs should support Routine Immunization Monthly.
  • Intensify Monitoring & Supportive supervision at State/LGA
  • Capacity building of the Routine Immunization
  • Sanction of nonchalant Health
  • Provision of Modern cold chain equipment at LGAs (refrigerators, freezers, solar freezers, generator and vaccines carriers).

Summarily from the interaction on RI funding In Niger State; it was submitted that there has been allocation to RI year in and year out but the allocation has not been backed up by any releases by the state Government to support RI activities in the state from 2015 to date. RI activities are largely being funded by partners in the state and also funds from SoML PfR programme under the care of the state. There also exists arrangement of basket funding with Niger State Ministry of Local Government, Ministry of Health and the state at large but it has not been implemented over the years under review. RI on the hand also have strong accountability platform through the emergence of SERICC

Day 02, 21st May 2019

Presentation on Family Planning:

This Desk Officer Family Planning of Niger State – Dorcas Abu (Mrs) who is the consultant on Family Planning took the stage on the second day of the meeting (21st May 2019). Her presentation which was titled FP Situational Analysis dwell through structure and indices of Family Planning, FP budget allocation and releases, Partners and Intervention, main objectives of FP intervention in Niger state, Programme implementation and update, Trends of FP acceptors, CPR rates, human resource as well as FP service uptake in Niger State.

In her presentation, after relaying the FP indices, she gave an X-ray of budget allocation and releases to FP in Niger State from 2015 to date. The allocations as given by her are as follows:

  • 2015-5 Million budgeted captured under general programs no approvals and Releases
  • 2017-50 million budgeted and captured under Nutrition code and in Dec.2017 the sum of 2.1million was approved and release by SOML
  • 2018-50M budgeted and captured under Nutrition code.8.9M was approved, and in Dec. 2018 the sum of N7.95M was approved and release by SOML
  • 2019 -100M budgeted   and captured under Nutrition code.8.9M is been approved, proposal written awaiting

She thereafter talked about partners working on FP in Niger State, the objectives of FP in Niger State as well as the programmes implemented so far. She later capped up her presentations with discussions around challenges of FP implementation and some recommendations for the PAS partners

Summary from the presentation and interactions with the FP consultants on the update of FP, the Situation of Niger State FP is as summarized below

  • Maternal Mortality ration is 576/100,000 lives birth (DHIS 2013)
  • Infant Mortality rate is 70/1,000(MICS,2016)
  • Under 5 mortality is 120/1,000(MICS,2016)
  • Use of Modern Contraceptive is 6
  • High unmet need of all women age 15 – 49 years (22.4%)
  • Contraceptive prevalence rate (CPR) is (6.6%)
  • Percentage of facilities providing FP services in Niger State is 41.5% as against the national percentage which is 4%
  • Modern contraception use in the state; about 33.3% uses at least three modern methods of Family Planning in Niger State as against that of National average which is 4%, Traditional method 1%, any other method 6%
  • No funding support to FP by Niger state government since 2015 except support from SOML in 2018
  • Niger State have in place 5yr CIP through Support of Pathfinder Int but not being implemented
  • In Niger State women have an average of seven (7) children each, and half of the population is under age fifteen (15) and thus will be entering child bearing age
  • Survey data indicate that there is high unmet need of 22.4% for FP information and services.
  • Nearly 1 in 6 (16%) married women ages from (15 to 49) will like to space or limit future birth but are not using any method of
  • Contraceptive Prevalence Rate (CPR) is 9.2% (MICS 2017).
  • Method of contraception use in the state: Modern method 4%, Traditional method 1%, any other method 1.6% (NDHS 2013).

Challenges of Family Planning Programming and funding

  • There is no dedicated budget line in the State for FP
  • Delay/non- release of budgeted funds
  • Non implementation of CIP for FP
  • Inadequate skilled service providers
  • Full take up of Integrated last mile distribution model yet to begin
  • Inadequate supply of consumables
  • Poor Male involvement


  • Advocate for timely release of funds for activities
  • Push for a budget code for RI in Niger State
  • Training of programme managers on work plan tracking
  • More commitment on adherence to timelines
  • Use of Ward Health Development Committees (WHDC), social mobilizers, CHIPS/CORPS to sensitize the hard to reach communities
  • Advocating for more supervision and mentoring
  • Service integration with LGA CCOs to transport commodities and consumables to service touch points
  • Develop proposal based on AOP/Costed Implementation Plan (CIP) to address identified challenges

Summarily, from 2016 to date there has been allocations to FP in Niger State though lumped with Nutrition code, but no single releases have been made to the state FP unit to date. The Basic Health Care Provision Fund and Save One Million Lives Programmes in Niger State have components for provision for Family Planning. Their also exist a five year Costed Implemented Plan (CIP) for FP in Niger State which was developed and validated in January 2017 and further embedded into annual operational plan developed in December 2018, with no funding support and not being considered for appropriation in the state budget for FP. Also the state has not fully domesticated the National Policy on FP.

Presentation By PHCUOR Consultant:

The Former Director Planning Research and Statistics of State Primary Health Care Development Agency – Mohammed Yakatun Bida made a presentation on the Update of the level of Implementation of PHCUOR Policy in Niger State. His presentation started from the law establishing Niger State Primary Health Care Development Agency. He relayed that Niger State Primary Health Care Development Agency was established by law passed by the NGHA in December 2009. The proposed amendment was concluded in 2014 and Gazetted in July 2015. It has a management team, with clear lines of accountability, led by an Executive Director who reports to the Governor through its Honourable Commissioner for Health. The agency have 5 departments each headed by a Director and their Deputies deployed from Head of service, Ministries of Health, Local Government, Finance and Hospital management Board.

Mandate of Niger State PHCDA is “To deliver the most effective, efficient, qualitative, integrated and sustainable Primary Health Care Services that is available, acceptable, affordable and accessible with equitable distribution to the generality of the population of Niger State, particularly the Rural Population with their active involvement and participation and development of Community based system and functional infrastructure”.

Sources of Funding to SPHCDA

  • State budgetary allocation (N116m/4years)
  • Partners’ financial support (N250m)
  • Basket funds – BMGF-MoU (N1.293bn)
    • BHCPF (1.5bn)
    • SOML P for R (USD, 1.5m yr1; USD 1.2m yr2);
    • USD 6M yr3

The consultant, thereafter, x-rayed the scorecards on PHCUOR so far produced, which according to him is the working document used to access the level of Implementation of PHCUOR in Nigeria. From his submission, he relayed that National scorecard III developed revealed that Niger state scored 61% overall in implementation of PHCUOR, ranking 6th nationally and 1st in the North Central geopolitical zone of Nigeria. The state scored high performance in Governance and Ownership domain (88%) and its lease performance in MSP domain (11%). He further relayed that following the scorecard 3 assessments on the Implementation of Primary Health Care Under One Roof in Nigeria which reveals some of the gaps on the level of PHCUOR Implementation in Niger State; topmost of which is the poor performance in the MSP domain with the score of 11%. Health Strategy Delivery Foundation (HSDF), one of the partners supporting working in Niger State supported the state to undertake the costing of MSP. This was thereafter followed by an independent assessment by HSDF on the implementation of PHCUOR in Niger State. This assessment which was conducted by HSDF reveals some challenges around Implementation of PHCUOR in Niger State as part of its findings. This according to him was followed by another National Assessment; Scorecard IV; Scorecard IV reveals that Niger State scored 73% in PHCUOR implementation placing Niger State in 2nd position nationwide, that its best performing pillars include MSP 83%, Human Resources 83% and Office Setup 100% with good performance in other pillars.

Status of Niger STATE PHCUOR Pillars





Governance & Ownership SPHCDA Board constituted


Legislation PHCUOR bill was first passed into law since 2009. A new law repealing that of 2009 and establishing 2014 has been passed.



Minimum Service Package (MSP) Adopted the MSP but resources have not been mobilized for implementation. Health facilities and classified.

MSP Developed


Human Resources There is inadequate qualified staff (Medical Officer of Health, Nurses / Midwifes, Community Health Extension Worker, Junior Community Health Extension Workers, Lab and Pharmacy technicians, Environmental Community Health

Officers, E.T.C)

Staff Audit Ongoing


Repositioning There is a formal orientation for managers to clearly understand their new roles and responsibilities at all levels

Job description



Systems development There is strategic and operational plan in place

Costed A.O. P


Operational Guidelines Operational guidelines for PHCUOR not domesticated and used effectively.

Operation Guidelines for PHCUOR yet to

be develop.


Office Setup Well-furnished office space exists at the state and sub state levels for the Board

New Structure



Funding structure and sources The Agency has a budget line.

There is council approval for Basket funding of the activities of the Agency which is yet to be operationalized.


However, in spite of the above report, Implementation of PHCUOR policy in Niger State from the interactions with the consultant still have some outstanding challenges. These challenges areas scaled out below:

Outstanding Challenges in PHCUOR Implementation in Niger State are

  • Lack of effective functioning of the constituted board to Niger State Primary Health Care Development Agency
  • Non transfer of Salaries and payment of PHC staffs across the LGAs from Ministry of Local Government and Chieftaincy Affairs to Niger State Primary Health Care Development Agency for effective Monitoring and coordination
  • Nonexistence of Local Government Health Authority but existing 25 LGA structures are recognized as authorities
  • On one functional PHC per ward, only 12 wards have functional PHCs out of 274 wards in Niger State
  • Task shifting in Niger state is concerned as an interim measure, and will have to be mplemented alongside other efforts to increase the numbers of skilled health workers and this will ensure a true assessment and consider using existing health workers.
  • Inadequate funding to SPHCDA from the State budget
  • Lack of dedicated budget line for PHCUOR / PHC strengthening in the state budget
  • Non fulfillment of 15% counterpart support from Ministry for Local Government and Chieftaincy Affairs to SPHCDA
  • Inadequate HRH in the primary health care
  • Poor state of physical infrastructures to support PHC system
  • Low Community Participation
  • Inadequate availability and supply of basic health commodities and other consumables at the PHC facilities
  • Poor Referral System
  • Inadequate funding of the primary health care system
  • Fragmented health information system
  • Poor management of financial resources allocated to primary health care programmes
  • Poor quality perception of health services in primary health care facilities


  • Budget line for PHC Strengthening and PHCUOR policy Implementation
  • High level advocacies for release of 15% support from Local Government incomes to SPHCDA and transfer of salaries from Local Government to SPHCDA
  • Regularization of the meetings of the Board to SPHCDA
  • Recruitment of skill health workers e. g Nurses/Midwifes, Chews and Jchews, Pharmacy technicians, lab technicians e.t.c, to man the PHC facilities and encouragement of Task Shifting Policy
  • Renovation of dilapidated PHC facilities across the state (SOML, BHCPF SDG, NG)
  • Activation of WHDC, Community engagement strategy and Taskforce committees
  • Provision of adequate supply of hospital consumables and commodities (SOML, SDG,DMA and Partners)
  • Provision of tricycles ambulances at HTR
  • Strengthening of SOML, Basket fund
  • The need to centralized M&E system and Control room (State & LGA)
  • Periodic auditing of account of SOML, BHCPF, BMGF and other sources of funding
  • Encourage community participation in day to day activities of Primary Health care Facilities in collaboration with WHDC.

Day 03, 22nd May 2019

Presentation on Childhood Killer Diseases:

This was done by the former IMCI Desk Officer of Niger State – Elizabeth Jiya (Mrs). The consultant took the participants through the background information on CKD, rational for Integrated Management of Childhood Illness 1-3 (IMCI-1 to IMCI-3), overview of Niger State IMCI, cases of pneumonia and diarrhea. From her presentation, she relayed that Malaria, pneumonia; diarrhoea, measles, and malnutrition combine to cause high morbidity and mortality (70%) in the under-five population. Vaccine preventable diseases alone are responsible for 20% of infant mortality.

Through the interaction with the consultant, the following are the findings on the situational analysis Childhood Killer Diseases (CKD) in Niger State:

  • Annual live birth = 195,000 of which 19,000 die before thier fifth (5th) birthday
  • For every 1,000 live birth, 100 of them will die before they mark their 5th birthday . This translate to one in every ten children in Niger state dying before they are aged five
  • Both Pneumonia and Diarrhoea constitute both 12% of under 5 deaths in Niger State
  • CIP in Place embedded into the state 5yr plan and not implemented
  • No domestication of National policy on CKD with new addendum added in place to support CKD services in Niger State

Outstanding Challenges of Childhood Killer Diseases

  • No budget allocation at both state and LGA levels, CKD activities are largely supported by donors
  • No budget line for CKD in the state Health sector budget
  • Non release of funds from state to support CKD activities in Niger State
  • Stock out of ors/zinc and dispersible amoxycillin at both health facilities and community levels
  • Poor data gathering
  • Drop out of CORPs
  • Very difficult terrain for regular supervision; many hard to reach communities (HTR)


  • Advocacies to strengthen political commitment of stakeholders
  • Budget line for CKD activities; especially for Pneumonia and Diarrhea treatment
  • Ownership by both state and LGAs to be less donor driven
  • Efficient and effective releases to IMCI department
  • Supportive supervision to ensure continuity
  • Better quality data generation for analysis and planning

Summarily, Niger State has no any specific policy or budget line on CKDs (pneumonia & diarrhea). All childhood illnesses are categorized and budgeted under child health. CHAI has been training and supporting health workers on treatment guidelines and essential drug for the treatment of pneumonia & diarrhea, as well as supply of drugs in Niger State.


  • Niger PAS partners knowledge strengthened on the project issue areas (FP, RI, CKD & PHCUOR)
  • Niger State PAS partners knowledgeable about the issues around the project thematic focus
  • Adequate information of Child and Family Health issue areas situations enough to support the production of issue briefs for the PAS project in Niger State known to Niger State PAS Partners
  • Niger PAS Partners informed on budget allocation, approved and releases and the bottleneck and funding gaps of child and family health issue areas known to Niger State Pas partners
  • Level of implementation of PHCUOR as well as PHC strengthening known and the outstanding challenges hindering PHCUOR policy Implementation known to PAS partners
  • Relevant / Key advocacy targets to change the tide of child and family health issue area policy implementation and funding identified
  • A sampled budget scorecard that can be adopted across project issue areas was shared
  • First-hand information on allocations, approval and releases for child and family health issue areas for 2018 and 2019 received by Niger State PAS partners
  • Consultants agreed to further partner with the team by providing any needed information and support in other to achieve the desired objective of the project

Key Recommendations

  • Niger Partners to undertake a high-level advocacy to principal targets like the Executive Governor, the Speaker House of Assembly/House Committee on Appropriation, Hon Commissioners for Health, Finance, Planning and Local Government as well some other key influencers in the state
  • Niger PAS Partners to produce strong advocacy support materials like issue briefs, press releases, fliers etc to support their advocacy course
  • Intermittent advocacies to relevant stakeholders to strengthen political commitment of the stakeholders
  • Sustainable domestic funding strategies to be created for child and family health issue areas to improve funding to child and family health issue
  • Budget line for child and family health will foster effective funding to FP, RI, CKD and PHCUOR Implementation

Next Steps

  • Niger State PAS Partners will do a desk review of the relevant documents collected to tease out situational analyses as well as other information’s that will further support the project
  • The team will also use the information gathered to produce issue briefs to support the project
  • The team will also develop concise advocacy messages from the issues to support advocacy course of the project


Time Activity Responsibility
9:30 – 9:50am Registration All
9:50 – 10:00am Prayers / Self-Introductions All
10:00 – 11:00am Presentation on the Update of Health Sector Budget of 2019 with focus on Child and Family Health Issue areas (FP, RI, CKD & PHCUOR) Senior Planning Officer Budget – SPHCDA

Abubakar Yanda

11:00 – 12:00pm Question and Answer Session All
12:00 – 1:00pm Overview Of RI Policy Implementation and Domestic Funding Schemes In Niger State State Immunization Officer

Dr. Samuel Jiya

1:00 – 2:00pm Comments, Question and Answer Session All
2:00 – 2:20pm Refreshment All
2:20 – 2:30pm Next Steps & Closure All
1:20 – 1:25pm Group Photographs/Departure All


Niger PAS Partners Assessment Visit to Selected PHCs in Niger State

The Niger State PACFaH@ Scale partners, with the support from the development Research and Project Centre, Abuja undertook an assessment visit to some selected facilities (PHCs) in Niger State. The team which comprises of selected members from across the sub-grantee CSOs of the dRPC undertook an assessment visit to identify key issues and updates regarding service delivery, uptake of child and family health issue areas of the project as well as the PHCUOR policy implementation in Niger State
Activities of the Project 
Activities of the project revolve around the clusters:
  1. Developing the evidence base for the advocacy visits
  2. Disseminating information briefs to the stakeholders and media and educating them on the advocacy issue
  3. Training Civil Society Organizations in Nigeria and mobilizing them to participate in advocacy visits
  4. Advocacy convening and follow up activities
  5. Building support within government by creating champions within the beaureucracy by working in collaboration with NIPSS
  6. Monitoring, Evaluation and Learning
In the quest for the fulfillment of the objectives of the PAS project implementation in Niger State, as well as having a background information on government support, service provision and uptake to child and family health issue areas (FP, RI, CKD & PHCUOR Implementation) at the PHCs in Niger State,  some selected members of the PAS sub-grantees in Niger State carried out facility assessment visit to some PHC centres in Niger State to assesses information on PHC service support, provision and uptake across child and family health issue areas (RI, FP, CKD & PHCUOR Implementation) in Niger State by Niger State Government and PHC staffs
Objectives of the Visit
  1. To assess availability of services, commodities and human resources as it relates to child and family health issue areas (FP, RI, CKD & PHCUOR) in the selected PHCs in Niger State.
  2. To assess the availability funding to support  child and family health issue areas (FP, RI, CKD and PHCUOR implementation) in Niger State
  3. To examine the level of the implementation of  BHCPF as well as the integrated services in the PHCs in Niger State.
  4. To determine the extent of implementation of Primary health care under one roof (PHCUOR) in Niger State.
The Visit Targets
  • In-charge and other staffs working in PHCs
Niger PAS PartnersTeam
  • Shehu Ahmed Baba – Program Officer CCRHS-PAS
  • Mr. Oladele Matthew – Monitoring & Evaluation Officer, CCRHS – PAS
  • Mary Jalingo – Monitoring and Evaluation Officer SERDEC- PAS
  • Ahmed Abdulsalam – Programme Officer SERDEC-PAS
  • Comrade Haruna Shuaibu  Tanko– Project Directr, NAMMN-PAS
  • Ibrahim A. Mairiga – Programme Officer NAMMN-PAS
  • Ibrahim Aliyu – Monitoring and Evaluation Officer, FOMWAN-PAS
  • Mallama Kuluuwa Abdullahi – ProgramOfficerFOMWAN-PAS
The Meeting Deliberations
The facility assessment visit which was through visitation by the Niger State PAS partners was guided by a well structures questionnaires; the primary data collection instrument involved using a guided checklist to interact with the PHC staffs. Ten (10) facilities were sampled for assessment by the PAS team; about six members of PAS team. The facilities visited are as follows:
  1. Maternal and Child Health Clinic, Old Airport, Minna
  2. Maternal and Child Health Clinic Tunga, Minna
  3. Senator Dr. Idris Kuta Memorial Primary Healthcare Centre
  4. FSP Medical Out-fit Minna
  5. Dije Bala PHC Suleja
  6. Salihu Madalla PHC Madala
  7. Yanna PHC Centre Bida
  8. Doko PHC Centre Doko
  9. Ubandoma Primary Health Care Clinic, Kontagora
  10. Maternal and Child Health Clinic Kontagora
The visit to PHCs by selected Members of Niger State PAS Partners which took place from 17-18 May 2019 was in an interactive form, guided by a well structured check list with questions around Child and Family Health Service Provision and Support; availability of Services, support to services, availability of commodities, funding to PHCs and availability of human resources as it relates to child and family health issue areas (FP, RI & CKD) in Niger State PHCs. Questions were also asked around availability of integrated services under one roof, BHCPF, Basic minimum package, Implementation of PHCUOR policy as well as availability of water supply and cleanliness of the structure.
Summary of Findings from the Field
  1. Family Planning: Findings from the field on Family Planning reveals that across all the PHC facilities visited, FP services are available with mixed methods in practice. However, none of the facilities receives funding from state for FP services except commodities that are supplied through SPHCDA by donors / partners in the state. On human resource for health, inadequate human resource for health trails all the PHCs visited as majority of the respondents relayed that human resources are between the ranges of 2-4 staffs with and that they are often supported by volunteer staffs who are often not paid by government
  2. Routine Immunization: Routine Immunization (RI) services on the other hand are also available across all the PHCs visited. On storage facility for vaccines, majority of the PHCs do not have equitable storage facility for vaccines; they only uses refrigerators or cold boxes while few do not have any form of storage facilities and collect vaccines from central cold store. Also, no funding is received by PHCs from state on services and commodities except for the payment of adhoc staffs and commodities supply which is being done by partners/donors. Across the facilities visited, inadequate human resource for health trails all the PHCs visited; they relayed that the number of staffs do not always meet the upsurge of the clients visiting their respective facilities.
  3. Childhood Killer Diseases: All the PHCs visited are using the new treatment protocol or guideline which is Amoxycillin DT and Zn-Lo-ORS for childhood pneumonia and Diarrhea. Respondents reveals that the drugs on the other hand are not readily available across the facilities visited; majority of the respondents relayed that drugs are recommended for clients/patients purchase from outside the facilities. For human resource for health, respondents across all the PHCs visited reveals that human resources for CKD are not adequate.
  4. Primary Health Care Under One Roof: For the availability of the integrated services of PHCs under one roof, some respondents relayed that it is not yet integrated while some reveals that it is but not all components of the services are available under one roof. On the BHCPF, majority of the respondents reveals that they have not started benefiting from the services as the programme has been mentioned but not started. Majority of the facilities do not deliver basic minimum package as relayed by the respondents; the reason being that facilities do not have adequate manpower like Pharmacy Technicians, H/E etc. About 70% of the facilities visited have water supply systems like boreholes and the structures are neat while 30% of the facilities do not have water supply system and their structures needs total renovation.
Major Outcomes
  • All the PHCs (100%) were found to be rendering all the child and family health issue areas services
  • None of the PHCs visited receives funding from the state to support services and service uptake at the PHCs
  • All PHCs visited receives partners support through the SPHCDA for services like payment of adhoc staffs and purchase of commodities and consumables
  • In some facility, FP commodities are available while in some non availability of commodities  trails some other PHCs visited
  • All the PHCs have Inadequate human resource for health to support servie provision at the PHCs; PHCs cannot effectively run shift as result of lack of required number of staffs
  • Volunteer staffs are found to be supporting services across all the  PHCs visited
  • All the PHCs have and follow new treatment guideline/protocol for treatment of Amoxycillin DT, Zn-Lo-ORS for childhood pneumonia and Diarrhea in Niger State
  • Partners largely support provision of commodities and payment of adhoc staffs
  • Implementation BHCPF programmes have not commenced in all the facilities visited
  • Implementation of integrated services under one roof not fully in place
Key Recommendations
  • Niger PAS CSOs to support the upgrading of PHC and her services through advocating for funds supply, adequacy of human resource for health as well as supply of commodities and consumables
  • Push for immediate commencement of BHCPF programmes
  • Advocate for full implementation of PHCUOR policy and PHC strengthening in Niger State
  • Niger PAS Partners to Advocate for PHCs to be equipped to render the integrated services under one roof

Next Steps

  • Niger State PAS Partners to use the information generated during the meeting with consultants
  • Niger state Partner to also use the information generated during advocacy engagement with policy makers in Niger State


Policy Brief on Use of ORS-Zinc and Amoxicillin as the First Line of Treatment for Diarrhea and Pneumonia in Kano State


Pneumonia is the single largest infectious cause of death in children worldwide.  It accounts for 16% of all deaths of children according to the WHO.

In Nigeria, pneumonia has replaced malaria as the number one killer of children under five, claiming 18% of all under-five deaths. According to the WHO, there were 148,772 under-five deaths due to pneumonia in Nigeria in 2004, falling slightly to 132,556 in 2015.

Diarrhea is also a leading killer of children, accounting for approximately 8 per cent of all deaths among children under age 5 worldwide in 2016. Diarrheal diseases, such as cholera and rotavirus, kill 1.5 million kids each year, mostly under 2 years old.

In 2018, Kano State recorded 31,477 cases of diarrhea in under – 5 children and 3,488 cases of pneumonia in the same category of children.

Trend of Some Child Killer Diseases in Kano

Source: State IDSR Reports

Lack of release of budgetary allocation hinders the supply of basic drugs to reduce the death of 0-5 years children that occur due to preventable diseases such as diarrhea and pneumonia. WHO recommended that use of Zinc-ORS and Amoxicillin DT as the First line of treatment which is very critical to achieving a significant reduction in child mortality.

Current Status

KNSG adopted 2013 the National Policy on the use of ZN-ORS for the management of diarrheal diseases and the State has included activities for childhood killer diseases in the 2019 AOP. For pneumonia activities in the State, only 20 SHFs have been covered with trained personnel and equipment. Thus, pneumonia services are covered in about 50% of SHFs in the State. Recently, HMB has distributed oxygen equipment to 3 additional secondary facilities (HBPH, Tiga GH and Kwankwaso Cottage) and will roll out the training on identification and management of pneumonia any time soon.


KNSG amended its treatment guideline to include Zinc-ORS and Amoxicillin as the first line treatment for diarrhea and pneumonia. Following the revision of the essential drug list in 2016, the State included Zn/ORS and Amoxicillin DT into DRF scheme.

Rationale for Advocacy

There is poor coordination and low capacity of staff at the State IMCI unit under the Ministry. Examination and drug administration are very critical elements in addressing childhood killer diseases. However, despite the availability of ORS-Zinc and Amoxicillin, many frontline health workers lack the required skills to attend to children suffering from diarrhea or pneumonia.

There is need for demand generation of amoxicillin DT across SHFs and high burden PHCs; HCWs need to know the use of Amoxicilin DT in the State; community need to know danger signs and identification; HCWs need to know symptoms and first line treatments.

Unavailability of treatment protocol for child killer diseases at primary and some secondary health facilities is one major of concern that could be addressed by awareness creation and sensitization of healthcare workers.

Despite the adoption of task shifting and sharing policy, diarrhea and pneumonia are serious diseases that shall always be handled by well-trained health personnel who are inadequately available in our health facilities.


  • The need to reactivate and strengthen the State’s IMCI unit for proper planning and implementation of childhood killer diseases in Kano
  • Training of HCWs in the remaining SHFs and the 18 high burden PHCs on management of childhood killer diseases.
  • Print and distribute treatment protocol documents on diarrhea and pneumonia diseases for the health workers reference
  • Facilitate effective coordination between three tiers/levels of health facilities/care in the state.
  • There is need for community awareness creation on the signs and symptoms of pneumonia

Benefits of the ORS-Zinc and Amoxicillin

Public Health Benefits

  • Avert unnecessary child deaths
  • Increase child development index
  • Value for money in purchase of drugs

Socio-Political Benefits

  • Improved human development index for the state
  • A healthy population that could add value to the state’s socio-economic development
  • Effective public health system at the grass-root level will reduce general health care spending and thus, other state critical health infrastructural needs can be met.
The Kano PAS Advocacy Coalition

This Policy Brief is a product of the Kano State PAS Advocacy Project.

The Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) project Nigeria, referred to as PAS is a health advocacy project anchored by the Nigeria non-profit, the dRPC and implemented directly by local NGOs and health professional associations. The project is not service delivery and it is not awareness creation. Its focus is limited to evidence-based advocacy.  The project’s timeline is 2018 to 2022 and the issue areas of the project are: Routine Immunization, Family Planning, Child Killer Diseases, and Primary Health Care Under One Roof. Focal states of the project are Anambra, Enugu, Kaduna, Kano, Niger, Rivers, Taraba and Lagos States.

In Kano State, the PAS Advocacy Coalition is made up of various civil society organisations led by Medical Women Association (MWAN), Women in Media Communication Initiative (WIM), National Association of Nurses and Mid-wives Kano State Branch (NANNM), Federation of Muslim Women Association of Nigeria (FOMWAN), Kano Emirate Council Committee on Health & Human Development (KECCoHD), Society of Gynaecologists and Obstetricians in Nigeria (SOGON), The Challenge Initiative (TCI), Accountability Mechanism for Maternal and Child health in Kano State (AMMKaS), Youth Environmental Development Association (YEDA) and Facility Health Committee Alliance (FHCA)