Kaduna State has progressed in enforcing the federal government’s Primary Healthcare Under One Roof (PHCUOR) policy but still lags behind in some aspects of the programme.
This was revealed by a team of assessors in the state for the scorecard assessment of the PHCUOR which is being done concurrently in the 36 states and Federal Capital Territory (FCT).
The scorecard assessment is a yearly exercise routinely done to continuously review successes and failures in the implementation of the policy.
The exercise is conducted by the National Primary Health Care Development Agency (NPHCDA) in collaboration with the Development Research and Project Centre (DRPC).
Each state is measured based on its level of implementation of the nine pillars guiding the PHCUOR policy,
After assessing key players and institutions responsible for the implementation of the policy in Kaduna, the NPHCDA monitoring team led by Runmonken Olalekan briefed the Executive Secretary of the State Primary Healthcare Development Agency (SPHCDA), Hamza Abubakar, on their observations on Thursday.
PHCUOR is a policy to reduce bottlenecks and fragmentations in the delivery of PHC services by integrating all PHC services under one authority.
The policy was approved by the National Council of Health in 2011 and backed by the National Health Act (2014).
It mandates every state to create an (SPHCDA) as a single management body to control all PHC services and resources especially funding, staff enrollment and the payment salaries.
Local Government Health Authorities (LGHA) will also be created with separate offices and staff to manage PHC activities at the local government level and answer directly to the SPHCDA.
The assessment exercise commenced on Monday with a visit to the state’s health ministry.
PREMIUM TIMES partnered with the DRPC to observe the assessment.
On Tuesday, the SPHCDA was graded based on the pillars guiding PHCUOR.
The pillars include A) governance and ownership – that states must establish a primary Health Care board (SPHCB) and Local Government Health Authorities (LGHA) with management and advisory team.
B) Legislation – an operational SPHCB Bill passed by the State House of Assembly, signed into law by the Governor must be in place with clear provisions on key requirements for the full implementation of PHCUOR.
C) Minimum Service Package (MSP): a developed MSP document starting with the classification of all PHC facilities based on minimum services to be provided including essential medicines/consumables, essential equipment and the required manpower.
The MSP is to be costed and investment plans developed to guide implementation following approval by the state government.
Wednesday took the assessors to three LGHAs and PHCs respectively in three senatorial zones in continuation of their assessment of the North-west state.
Briefing the SPHCDA executive secretary, Mr Olalekan said Kaduna should be given a “standing ovation for enforcing governance and ownership”, the first of the nine pillars.
He, however, noted that many states in the North-west region could not maintain such fit in “legislation” because it is yet to review and operationalise the SPHCB law.
He also noted that several LGHAs and PHCs do not have signposts to identify them as required by the PHCUOR guidelines.
The NPHCDA official spotted fluctuations in the state’s child and maternal death rate.
The assessor said the state is yet to move programmes such as HIV, malaria and leprosy under the SPHCDA as required by the policy.
The team leader also noted several shortfalls such as inadequate manpower and insufficient cash backing in three of the PHCs observed.
Mr Abubakar, while responding to some of the shortfalls observed, described the assessment exercise as a “welcome development” that has helped the state in improving implementation of the PHCUOR policy.
‘How we Score states’
Earlier before the briefing, Mr Olelekan explained to PREMIUM TIMES how the exercise states scored under the nine pillars.
He said after the field exercise, the assessment card will be taken to the Nigerian Governor’s Forum (NGF) for “validation”.
“The scorecard will now be presented at the annual NGF meeting to governors to know areas their states are performing and identify where to improve.”
The official said the annual scorecard has proved to be efficient in helping states identify areas to improve on in their healthcare delivery services
The scorecard serves as an advocacy tool for engaging policymakers including state governors as well as other PHCUOR actors in all states to improve political commitment and funding for PHC services.
“Many states have improved after applying recommendations from previous scorecards,” he said.
“For instance, it was after the first scorecard that many states created the office of the SPHCDA separate from that of the Executive Secretary as required under the nine pillars”, he said.
The official also said recommendations from the scorecard guides states and partners in targeting support for improving PHCUOR policy.