Nasarawa state, a purely agrarian state located in North-central Nigeria is reported to have the highest rate of Maternal and infant mortality within the region.
With a population of about 2 million people, the state loses about 700 hundred women per 10,000 live births and 103 children per 1,000 live births annually.
Access to Maternal and Child health related services is reportedly low in Nasarawa State due to challenges in the operations and capacity of the health facilities. Many of the facilities are unable to provide quality health services to effectively meet the needs of clients.
According to health workers in the state, factors such as unavailability of skilled professionals at the health facilities, ill motivated staff, poor working conditions to include lack of essential drugs, consumables and equipment contribute to the general poor service delivery in the State. These hindered residents from seeking and accessing healthcare thus most women turn to traditional birth attendants who often lacked the skills to handle complicated obstetric cases.
Although the state has grappled with this ugly trend for years, it has over time witnessed enormous investments in the health sector through government and development partners, yet the reports showed persistently low health indices.
In a move to curb the trend, the state Government in 2011, with Support from the World Bank keyed into the Nigerian State Health Investment Project (NSHIP) to adopt the Result Based Funding approach to healthcare financing.
This represents a paradigm shift from the previous style of input financing to a more evidence based output approach to strengthen service delivery and performance at the health facilities using the performance based financing method PBF.
This method expected to spur significant progress in maternal and child survival in the state through interventions redesigned to deal with client centered needs is being implemented in over 86 Primary Health clinics and 6 General hospitals across the 13 Local Government Areas of the state.
The expectation is fast yielding results as a trip to some of these implementing sites revealed an unusual buzz of activities, uncharacteristic of Primary Health centers in Nigeria.
The outpatient departments OPD are now filled with clients awaiting their turns as clinical consultations go on in the side rooms.
Pharmacies and laboratories are better equipped with essential drugs, consumables and equipment for effective service delivery.
In Model Primary Health centre, Wamba for instance, Antenatal coverage has risen from 20% to over 70% since the introduction of the PBF strategy.
Prior to the introduction of the NSHIP strategy, most of the health care facilities in the state were in dire need of rehabilitation, essential drugs, consumables, equipment and a proper waste management system. But with support of the PBF Intervention, most of these facilities have been refurbished, more structures added where necessary, drugs, and equipment acquired and standard incinerators built for proper waste disposal and management.
A significant feature is that most of these clinics are now well staffed and equipped to offer 24 hours service making it easier for women to have safer deliveries at all times.
For the officers in charge of these facilities, the success recorded so far is all thanks to the support the clinics enjoy from the NSHIP Intervention under the PBF funding Scheme. They compare the situation at the clinics before and after the intervention.
According to the health workers, projects such as this, is often challenging to gain acceptance amongst the people whose attitude towards seeking healthcare is strongly characterized by apathy. Amongst them usually are traditional healers and birth attendants with whom they often have a history or trust in and so will patronize regardless of the cost.
Thus for the successful implementation of the project, the traditional council and the Ward Development Committees were involved in the sensitization drive to reach out to the people and encourage patronage. They also monitor and evaluate activities at the clinics, stepping in to resolve issues when need be.
The increased client intake meant a challenge for the various clinics due to the paucity of human resources available. But this was short lived as the NSHIP provided support for the engagement of more skilled personnel to carter to the needs of its primary targets – women and children under 5 years.
At the heart of this project is its ability to ensure efficiency and sustainability by rewarding high performance by staff and facility.
The project also covers capacity building for staff through local and international trainings. Some of the beneficiaries were seen undergoing a practical training for the Integrated Management of Childhood Illnesses IMCI at the Dalhatu Araf Specialist Hospital in Lafia.
For the instructors and participants alike, the training is important to boost health workers capacity for proper diagnosis and management of childhood diseases; a key component in reducing under 5 mortality.
A core objective of this Project is to enhance the delivery and use of high impact maternal and child health interventions to improve quality of care at the primary health facilities. To this end, it emphasizes and trains health workers on data collation and records keeping for efficient planning, monitoring & evaluation of activities at the facilities.
The project employs the use of independent verifiers to evaluate claims of performance by the various clinics and a committee set up to check price regulation.
The Executive Chairman of Nasarawa Primary Heathcare Development Agency, Dr. Muhammad Usman Hadis, stated that the state has overcome any likely drawback in the implementation of the NSHIP project. He said the state had a budget code to support the project. NSHIP has helped Nasarawa state to overcome the “out of stuck” syndrome for drugs. With NSHIP, the state has security stock in pharmaceutical services, which enabled each facility to have a minimal quantity of drugs always. The project has also contributed to waste management within health facilities in Nasarawa State.
Amechi-Somto wrote this piece from Lafia, Nasarawa State.