The PACFaH@Scale project program areas are identified as issue based campaigns around government’s poor funding in four major areas implemented through the project partners.
Primary Health Care Under One Roof
Nigeria has committed to achieving Universal Health coverage (UHC) for its citizens, however, progress has been very slow with persisting high child and maternal mortalities, poor access to health services and high cost of services and a lot of hardship accruing from health costs. Though, Nigeria has embraced the principle of primary health care as bedrock to attaining UCH, these efforts are continually undermined by structural and institutional weaknesses. With fragmentation of health sector at sub-national level, including management staff, resources and sources of funding the PHC.
In May 2011, the 56th National Council of Health (NCH) endorsed the Primary Health Care Under One (PHCUOR) also known as Integrated PHC Governance policy agenda to integrate all PHC structures and programs under one State led body as State Primary Health Care Agency/Board (SPHCDS/B) within the framework of a decentralized health system. The policy is based on the principle of “Three Ones” i.e. one management, one plan and one monitoring & evaluation system. However, 7 years on, progress of the policy adoption/implementation has been very slow with many states at different stages. Results of the Scorecard 3 assessment of the PHCUOR of 2015 showing above 50% adoption/implementation in only 15 states.
The PACFaH@Scale project will use evidence-based advocacy to strengthen the policy implementation of the PHCUOR policy at the national level and 3 states (Kaduna, Kano and Niger). This will be done by four civil society organizations/professional associations:
- National-level Advocacy - National Association of Community Health Practitioners of Nigeria (NACHPN)
- Kaduna State – Association of Public Health Physicians of Nigeria (APHPN)
- Kano State – Aminu Kano Center for Democratic and Research Training (AKCDRT)
- Niger State – Center for Communication and Reproductive Health Services
According to WHO, vaccination has greatly reduced the burden of infectious diseases and immunization can save a child’s life and protect the quality of their livelihood. With adequate interventions for immunization in Nigeria, time and money expended on treating/managing vaccine preventable diseases can be avoided.
This is the current situation of immunization in Nigeria:
The 2013 NDHS shows that about 25% of children (age 12-23 months) had received all the recommended vaccinations (DPT, BCG and Polio vaccines), while 21% of eligible children received no vaccination at all.
As a lower Middle Income Country (LMIC), Nigeria will graduate from GAVI support, beginning in 2015 and will be responsible for full payment for vaccines by 2020.
GAVI graduation is calculated at 15% increase in Nigeria co-financing in 2015 and linear increase in co-financing obligation between 2015 and 2020.
For 2015, the total requirement for vaccines is $225 million, with Nigeria government making available $105 million, and GAVI making available $120 million. Going by 2014 funding level, there is an anticipated funding gap of $72 million starting 2015 and in 2017 this gap has increased to ...
There is need to increase domestic budget for RI and ensure timely release of funds for vaccines procurement and logistics.
There is need to strengthen accountability mechanism for RI in line with National Routine Immunization Strategic Plan, to ensure working groups function more effectively.
The PACFaH project advocates for; Increase in domestic budget and ensure timely release of funds for vaccines logistics.
The Federal Government provided only N1.2bn on Family Planning programmes in the 2018 Budget. This is grossly inadequate and has fallen short of the commitment made by the government during the London Family Planning Conference (LFPC) in 2012.
At that conference, Nigeria made a pledge to provide N3.6bn ($11.5mn) for family planning and reproductive health commodities as its commitment towards ensuring the attainment of the National Blueprint on Family Planning plan. (Scale-Up Plan 2014 – 2018).
This inadequate and poor funding has cascaded to the state government levels where Family Planning is grossly provided for in many states budgetary allocations in the 2018 Health budget provisions.
PACFaH@Scale is working with AAFP(National level), AKCDRT (Kano), SOGON(Kaduna), CCRHS(Niger), and NNNGO (Lagos) to advocate for more funding at the National and state levels in Nigeria.
Ending Child Killer Diseases
Pneumonia and diarrhoea are leading killers of young children. These diseases though preventable and highly treatable using simple measures and medicines remain top causes of under-5 mortality in the world. They account for about 29% which is over 2million of the 6.9 million under-5 child deaths. The burden of death is further concentrated in the poorest communities and countries and among the underprivileged children within the societies. About 90% of all deaths from these conditions occur in Sub-Sahara Africa and Asia. However, a World Health Organization report indicates that three-quarters of these deaths occur in just 15 countries, and more than half occurring in five countries: India, China, Bangladesh, Pakistan and Nigeria.
In 2012, Nigeria as co-chair of the UN Commission on Life-saving commodities for women and children identified and endorsed to increase access to the use of essential medicines, medical devices and health supplies in 13 priority areas including pneumonia (using Amoxicillin dispersible) and diarrhoea (using Low-osmolarity Zinc-ORS). However, 7 years after, the use of these essential life-saving commodities remains very poor with many states not adopting/implementing the strategy. The PAS project aims to increase the implementation of the policy to end childhood killer disease using low-cost effective interventions.
According to the World Health Workforce Alliance, Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, it also has densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000). Conversely, in some parts of the country, there are many employed but under-utilized health care workers who can be trained to competency and given specific responsibilities for the care of vulnerable Nigerians in hard to reach areas. Community health extension workers belong to this group.
The introduction of the National Task Shifting and Sharing Policy is a significant decision towards the scaling up of access to effective and evidence-based essential health services in Nigeria and bridge these identified gaps in the human resource for Health in the country. TSTS is, therefore, aimed at increasing access to services currently included in the essential health package in an effort to significantly reduce Nigeria’s unacceptably high mortality ratio/rates and to achieve the set Sustainable Goal (SDG) targets for the country.
Though the TSTS policy was approved for implementation at the 57th National Council on Health (NCH) meeting held at Uyo, Akwa Ibom State in October 2014, its implementation has faced many challenges including:
- Lack of operational plan “Standard Operating Procedure”
- Slow pace of domestication by the states: as at May 2018, less than 12 states in Nigeria have adopted the policy
- Focus on Public Health Facility
- Opacity with level of implementation
- Funding gap
- Others include lack of understanding of the policy by states and other actors
As the Federal Government of Nigeria begins the review of this policy, the involvement of critical CSOs in the review process becomes imminent. Apart from the technical and operational support that they would bring to the review, they would ensure accountability and dissemination of the revised policy that is expected to improve the human resource for health gaps in the country. Development Research and Projects Centre, dRPC, under the Partnership for Advocacy in Child and Family Health At Scale, PACFaH@Scale is working with CSOs in 4 states of Taraba, Rivers, Anambra and Enugu to advocate for the adoption and implementation of the TSTS policy.
It is believed that, the successful implementation of the TSTS policy across the 36 states and FCT will greatly improve coverage of RI, reduce cases of CKD, and improve access to Family Planning services.