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

Lagos, PAS

Introduction

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 54^th 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

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

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

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

National Primary Health Care Development Agency (NPHCDA) Abuja

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

Epidemiological Society of Nigeria (EPISON) Participants

Dr Mathew Ashikeni from Fct, Abuja
Dr Moses Daniel Chingle from Plateau state
Mrs A. Amn Olaniyo from Lagos state
Dr Y. Adamu
Mrs C. Chukwudike
Dr A. Oyemakinde
Professor S.T. Yahaya
Dr. J. Coker
Professor Ekanem Ekanem
Professor Oladele O. kale
Professor S.A. Omilabu

Participants from State Primary Health Care Board (SPHCB)

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

dRPC-PAS Participants

Mallam Hassan Karofi
Mustapha Kolawale
Sani Ochepo
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