Bauchi State, USAID IHP: Changing the Narrative in Primary Healthcare Services
By Bashir Hassan Abubakar
Successive governments in Bauchi State had, at one point in time, battle with challenges bedevilling it’s health care system, particularly in efforts aimed at changing the negative health indices.
Suffice to say, effective and efficient primary healthcare and accessibility of such services are some major entry point to an improved healthcare system not only in Bauchi state but the entire country at large.
Primary healthcare system is the first access point of orthodox medicine for greater majority of the populace, especially in the semi urban and rural areas of Bauchi state. Most of the services rendered by the primary healthcare facilities (PHCs) at these levels majorly focused on Reproductive, Maternal, Neonatal, Child Health, Malaria and Nutrition (RMNCAH+MN).
Statistics have shown that maternal, neonatal and child health status in Nigeria is among the poorest, the world over. Maternal deaths in Nigeria, according to WHO in 2015, was estimated at 58,000 deaths annually. Also in the 2013 NDHS, Nigeria’s maternal mortality ratio was put at 576 per 100,000 live births. Most of the maternal deaths were due to bleeding after birth (haemorrhage), post-delivery infections (sepsis), prolonged obstructed labour, eclampsia etc. Malaria also contributes to some of these deaths.
A quarter of the deaths within under five age bracket in Nigeria are new-borns. The deaths of babies within the first one month as calculated by the NDHS from 2008 to 2013 was 37 per every 1000 live births within the period. Experts believe that most of the neonatal deaths are preventable through proper immunization and good health seeking behaviours.
It is instructive to note that greater part of this negative health indices comes from the North Eastern region of Nigeria and Bauchi State, being part of the region, contributes it’s fair share of these health burdens.
The health statistics in Bauchi State has been of concern to government and other key stakeholders. According to a multiple indicator cluster survey of 2016-2017 (MICS) 41 neonatal deaths are recorded in every 1000 live births, while 161 under five deaths are recorded in every 1000 births. The MICS also revealed that only 19 percent is being recorded in immunization coverage among children. This indicates that greater majority of under five children do not get the required immunization dosages to prevent them from child killer diseases.
These painful health indicators in Bauchi state is being confounded with a grossly inadequate trained human resources to effectively provide services in the healthcare facilities, particularly in the rural areas, where most of the above health indices are emanating from.
Perhaps these challenges were some of the reasons why a USAID funded Integrated Health Program (USAID IHP) supported Bauchi state in the training of the few health service providers to equip them towards providing basic health care services effectively without compromising standards. The USAID IHP intervention had introduced the health facility-based training targeting some health service providers in some selected PHCs in Bauchi state.
The training, primarily focused on providing quality services in Reproductive Health, maternal, New-born, Child Health, Malaria and Nutrition (RMNCH+MN) at PHC level in the state, has greatly improved healthcare services in communities.This can be seen in the influx of clients seeking for services in such facilities.
A recent visit to Madangala PHC, in Katagum local government area saw some clients happily accessing these services. The atmosphere at the facility was warm and friendly. Service providers were seen attending to clients in a professional manner. One of the client Aisha Adamu, who was there for antenatal services told our correspondent that she had her two children at the facility and awaiting the arrival of the third.
“I can tell you without any fear of doubt that, antenatal and post natal care services has greatly improved in this facility. I am being attended to by a more caring and courteous personnel. I saw improvement in not only antenatal and post natal care services, but also in diagnosing minor illnesses in small children and adults too. Test are being conducted before medications are given. Service providers seem to know what they are doing. They inspire confidence in clients”, said Aisha Adamu
The current administration in the state has also made good it’s promises in providing quality healthcare services to the citizens. The government had leverage on the existence of international partners in the state, intervening in the different components of RMNCH+MN in the PHCs. The state government, through it’s primary health care development agency (BSPHCDA), had created the enabling environment for IPs intervention through prompt payment of counterpart funding where it becomes a requirement. The state has also continually sustained the relative peace enjoyed in the state. The most recent of atmosphere was flag off of the state health insurance scheme and the renovation and equipping of PHCs.
The Governor, Bala Abdulkadir Mohammed, had on several occasions reiterated the administration’s resolve in making a difference in healthcare system.
He appointed professionals to manned both the ministry of health, the state primary health care development agency and other health related MDAs in the state. Also, under the current dispensation, the state organised the first ever health summit, where experts from within and outside the state, which includes the minister of health, were invited to reassess the entire health care system and to proffer a way forward for the state.
The Governor, who suspended all his other activities, was in attendance throughout the entire three days summit, listening to key findings of experts and their recommendations.
In his remarks at the end of health summit, the Governor pledged to implement the recommendations of the experts to the latter, in accordance with available funds.
The strategic approach of training service providers at the facility level adopted by USAID IHP was based on the fact that 77 percent of Maternal and Neonatal deaths occurred at community level, where PHCs played significant role in mitigating such deaths.
According to the Bauchi State program director of USAID Integrated Health Program Dr. Alhassan Siaka, the objective of the training initiative was to provide technical support at facility level without hindering healthcare services to women and children in the selected PHCs.
Dr. Siaka, who was briefing health reporters recently at a follow-up training workshop organised by USAID IHP, said that, part of training also targeted health information management system at the PHC . This, according to him, is aimed at improving the quality of data generated at the facility level.
He also said that the criteria for the facility training was that, benefiting PHC must have at least three health personnel with requisite requirements.
Also, as part of sustainability plan, which is inline with the USAID IHP program’s objective, the program has trained master trainers so that they could pick up from where USAID IHP stops at the exit of the program.
It is worthy of note that the health sector in Bauchi State is enjoying a tremendous support from international partners (IPs) in the different components of health. For instance, while some of the IPs like USAID IHP are focusing on leadership/governance, health financing, improved HMIS, human resource for health et al, others are channelling their support in the areas of renovation/equipment, supply of drugs/commodities, development of score cards as an advocacy tool kits etc.
All these support the state is enjoying may not be unconnected with the commitment of the current administration towards an improved healthcare system. Already the state had paid up it’s 2021 counterpart funding of over 300 million naira into the primary health care basket fund.
It is also gladdening to note that all these supports has translated in the upscaling of services like ANC, delivery at facility, post natal care, routine immunization, child birth spacing, malaria treatment, reproductive health, nutrition et al.
Just recently, during a media assessment tour of some health facilities in Katagum Local Government Area of Bauchi state, there were heart warming testimonies on how services has greatly improved.
Yanbiyu Uba , the officer incharge of Makara Huta PHC informed the visiting team of the significant improvement in the uptake of ANC and other services at the facility.
“We now accommodate between 70-80 births here in this facility in a month. ANC services has also improved with over 100 percent attendance. There is also an impressive uptake in family planning services too. It may interest you to know that some clients even used their money to buy some of the FP commodities anytime we run short of such commodities”, said Uba.
Another client at the Bidir PHC, a 29 years old mother of four, Salamatu Isa confided to our correspondent on how she and her family members are enjoying the services provided at the PHC.
The client, who spoke in the local dialect said, “my entire family don’t have any need to go to any bigger hospital. We get all the services we need here in this PHC. They conduct tests, provide drugs and other essential commodities with little or nothing to pay. You can also see how the environment is looking so clean and tidy, with television and decoder to keep us entertain while we wait for services. My prayers are, whoever is responsible for bringing this changes in the PHCs, may Allah reward them abundantly. We in the rural areas don’t require much to keep us happy and these are some of these few things that keeps us happy”, she concludes.
In her testimony too, a service provider in Bidir PHC Maryam Sakwama also appreciated the Bauchi State Primary Healthcare Development Agency and IHP for building their capacity for optimal performance.
“The all encompassing facility level training has greatly enhanced our capacity. The absence of one service provider can’t affect service delivery here, because of the Integrated and sometimes hands on training we under went. I can perform the next person’s tasks and vice versa. It is like a tasks shifting, to make up for the inadequate human resource”, said Sakwama.
Truly, the challenge of inadequate skilled service providers is like a sore thumb that is threatening to dampen the zeal and enthusiasm of the service providers in the PHCs.
In some of the health facilities visited, it was discovered that the number of skilled permanent staff is grossly inadequate, with some of the PHCs boasting of only one or two skilled personnel.
But the good news is, just some few days ago, while on a routine inspection of some of these primary health centers, the Bauchi state Governor, Bala Mohammed has assured volunteers working in these PHCs in the state of his administration’s commitment to absorb them permanently as health workers saying that very soon the state government will free resources and employ them.
With these commitments and pledges on the part of Bauchi State Government and the support of IPs, like the USAID IHP intervention, it can rightly be said that primary healthcare services in the state will soon be a reference point for other states to learn from, that is, if the tempo can be sustained?