Background/Justification

The Niger State PACFaH@ Scale partners under the support from the development and Project Centre, Abuja undertook an assessment visit to some selected facilities (PHCs) in Niger State. The team which comprises of selected members from across the sub-grantee CSOs of the dRPC undertook an assessment visit to identify key issues and updates regarding service delivery, uptake of child and family health issue areas of the project as well as the PHCUOR policy implementation in Niger State

Activities of the Project

Activities of the project revolve around the clusters:

1. Developing the evidence base for the advocacy visits
2. Disseminating information briefs to the stakeholders and media and educating them on the advocacy issue
3. Training Civil Society Organizations in Nigeria and mobilizing them to participate in advocacy visits
4. Advocacy convening and follow up activities
5. Building support within government by creating champions within the beaureucracy by working in collaboration with NIPSS
6. Monitoring, Evaluation and Learning

In the bid to effectively achieve the investment outcome of the project that the development Research and project centre sub-granted some selected CSOs to work in Niger state across the selected issue areas of the project. On this, Centre for communication and Reproductive health services (CCRHS), Socio Economic Research and Development Centre (SERDEC), National association of Nurses and Midwifery Council of Nigeria (NAMMN) and the Federation of Muslim Women Association of Nigeria (FOMWAN) are sub-granted to undertake the implementation of the PAS project in Niger State focusing on Child and family health issue areas of the project.

Niger Pas partners role on the PACFaH@ Scale Project in Niger State aims to achieve the following:

• Increased budget allocation to FP, RI, CKD and Implementation of PHCUOR
• Value-added budget tracking for effective and timely release of funds dedicated for FP, RI CKD & PHCUOR
• Improved leadership commitment and capacity to identify and plan for sustainable sources of funding for FP, RI, CKD and PHCUOR in project timeline and beyond

It is expected that beyond the lifetime of this project, there will be:

• Increased in government’s commitment to fully fund respective agencies saddled with the responsibilities of the issue areas of the project
• Adequate budgetary allocation for the four thematic areas
• Timely release of allocated funds
• Strengthened partnership of indigenous CSOs around the four thematic areas

Against this background and in the bid to effectively achieve the desired objective of the project that the Niger PAS partners unanimously developed a consolidated work plan to be implemented across the period of May –June 2019. From the work plan and to have the required base line information to support the development of advocacy support materials (Evidence based), the group hired some consultants across the PAS project issue areas including budgets to collate some relevant base line information and specific updates as it relates to RI, FP, CKD and Implementation of PHCUOR policy/PHC Strengthening as well the funding of the issue areas. As part of the mandate of the consultancy. the consultants thereafter had a two hour interactive meetings with Niger State PAS partners comprising of CCRHS-PAS, SERDEC-PAS, NANNM- PAS and FOMWAN-PAS

Objectives of the Meeting

• To give an update on the level of implementation of the policy and funding of FP, RI, CKD and PHCUOR
• To generate baseline information and evidence on the issues around child and family health policy implementation and funding to support the advocacy course of the project in Niger State
• To identify gaps and challenges around policy implementation and funding of child and family health issues in Niger State
• To strengthen the knowledge and understanding of the PAS partners on the areas of focus of the PAS project
• To identify bottlenecks and gaps in Child family health programme implementation and funding as well PHCUOR policy implementation and hence deliberate on better strategies to achieving the desired outcomes of the project

The Meeting Targets

• RI Consultants – Dr. Samuel Jiya (State Immunization Officer)
• FP Consultants – Mrs Dorcas Talatu Abu (FP Coordinator)
• Budget Consultants – Mall Abubakar Yanda (Chief Planning Officer Budget)
• PHCUOR Consultants – Mohammed Katun – (Former Director Planning Research and Statistics SPHCDA)
• CKD Consultant – Mrs Elizabeth Kalima Jiya – Former Niger State IMCI Coordinator

Niger PAS Partners Team:

CCRHS PAS Team:

• Aliyu Yabagi Shehu – Project Director CCRHS-PAS
• Tijanni Abdulkareem
• Shehu Ahmed Baba – Program Officer CCRHS-PAS
• Oladele Matthew – M&E Officer CCRHS-PAS
• Rhishama Auta Sule – Project Accountant CCRHS-PAS

SERDEC PAS Team:

• Tijani Abdulkareem – Project Director SERDEC PAS
• Ahmed Abdulsalam – Program Officer SERDEC PAS
• Mary Jalingo – M&E Officer SERDEC-PAS
• Aisha Isa Kagara – Project Accountant SERDEC-PAS

NAMMN PAS Team

• Haruna Shuaibu Tanko – Project Director NANNM-PAS
• Ibrahim A. Mairiga – Program Officer NANNM-PAS
• Abdullahi N. Mohammed – M&E Officer NANNM-PAS
• Nasiru Sani Aliyu – Project Accountant NANNM-PAS

FOMWAN PAS Team

• Kulu Abdullahi – Project Director FOMWAN-PAS
• Gogo D. Abubakar – Program Officer FOMWAN-PAS
• Ibrahim Aliyu – M&E Officer FOMWAN-PAS
• Yakubu Adamu – Project Accountant FOMWAN-PAS

The Meeting Deliberations

The interactive forum with the consultants which took place across the span of three (3) days started from Monday the 20^th May 2019 to Wednesday the 22^nd May 2019. The meeting had two consultants on a schedule to present their findings on plenary for days 1 and 2 and one (1) consultant for day 3. Consultants for Budget and Routine Immunization presented on the 20^th May 2019, while consultant for Family Planning and PHCUOR Policy Implementation presented on the 21^st May 2019 while the Consultant on CKD presented on the 22^nd May 2019. The three days meeting had similar itinery as agenda which is in the following order:

• Opening Prayers/ Self Introductions
• Plenary Presentation of Findings by Consultant 1
• Comments, Question and Answer
• Plenary Presentation of Findings by Consultant 2
• Comments Question and Answer
• Wrap up / Next steps
• Closing and Departure

The meeting on daily basis across the span of three days commenced at about 9:00am with an opening prayers and self-introductions by all the members present. Presentation of findings by respective consultants with comments, question and answer session following each presentation by the consultants. Across the three days meeting, each consultant was given a maximum of two hours for presentations / comments, question and answer.

Day 01, 20th May 2019

Presentation by Budget Consultants:

The Senior Planning Officer Budget of Niger State Primary Health Care Development Agency – Abubakar Yanda started the day. He made a presentation on the “Update of Health Sector Budget of 2019 with Focus on Child and Family Health in Niger State” The budget consultant presented his findings through a power point projection; his presentation took the participants through the concept of budget, budget circle, health sector budget, update / break down of child and family health approved budget of 2018/2019 as well as budget tracking.

His presentation which in the first phase was on concept and component of budget started from the definition of budget, revenue, expenditures and its other components as well as other budget preparation components. Definitions of terms related to budget as given by the consultant are as follows

Budget as an annual financial and economic plan that serves as a vehicle for the mobilization, allocation and management of resources; a framework for revenue and expenditure outlays for a period of one year; as well as a list of planned Expense and Revenue: it is therefore a plan which sets out the programmes of projected government revenue and expenditure geared towards achieving policy targets.

• Revenue: is the flow of money accruing to an individual, firm or an economy over some period of time. It may come in terms of gift (Aids & Grants), cash or kind. In order words, Revenue is flow of wealth accruing to an individual, firm or
• Expenditure: refers to expenses incurred by individual, firms or Expenditure incurred by the government is known as public expenditure. This type of public expenditure in Nigeria deals with both expenditures of Government at Federal, State and Local Government levels
• Recurrent Expenditure: is the Government expenditure on the consumption of goods and services, i.e immediate
• Capital Expenditure: is the Government expenditure intended to create future benefits such as expenditure on the     provision of Infrastructure, Research and other developmental projects. It can be referred to investment of goods and
• Resource Projection: it is the estimation of the income (revenue) that are likely to come to the State in the coming year. The trend of past inflow (receipt) serves as the basis for the projection of revenue for the coming year.
• Call Circular: it is a letter containing budget guidelines and instructions accompanied by formats usually issued out to MDAs by the Planning
• Bi-lateral Discussions which he said referred to MDAs reporting to the planning commission on schedule for discussion in order to identify and agree on projects/programmes to be captured in the Budget in line with the government policies and priorities in consideration with the available

The consultant further took the partners through the reason for budgeting, the budget process of Niger State and budget preparation as well budget implementation process.

The Budget process of Niger State as given by the consultant are:

• Recurrent expenditure: (By Ministry of finance)
  • e-salary
  • Monthly releases of over head to MDAs
• Capital expenditure:
  • Issuance of budget clearance certificate (in principle)
  • Obtaining approval
  • Obtaining Certificate of No Objection for PPB
  • Issuance of final budget clearance (clearance for release of funds)

He further talked on some budget control processes which involves carrying out of Budget performance analysis on quarterly bases, Monitoring of capital projects, Presentation of Monitoring and Budget performance reports to the Executive Council for possible corrective measures, Periodic discussions between the State House of Assembly and implementing MDAs on budget performance (Oversight functions of the SHoA), Auditing by the office of the State Auditor General. The consultant capped up the first phase of his presentation by relaying to the group, challenges around budget allocation, approvals and releases in Niger State and some recommendations for intervention by the PAS team

The second phase of the presentation by the budget consultant took the participants through the breakdown of of 2018 / 2019 budget allocations, approved and releases for SPHCDA and that of Child and Family Health Issue areas (FP, RI & CKD); see attached documents for details. From the budget breakdown given, it was observed that from 2018 to 2019, allocations are made for FP, RI & CKD with approvals but are not always backed up by releases. Even the SPHCDA suffers the set back of inadequate allocations and releases; that child and family health survives at the mercy of support from SoML and partners working in Niger State.

The third phase of the presentation by budget consultant took the participants through budget tracking process guided with a draft copy of budget tracking tool. The sampled tracking tools have two parts with first part on Health sector budget and the second part on Routine Immunization. The indicators across are; % allocations to health compared to State total budget, % recurrent and expenditures compared to state health total as well as RI budget tracing tool focusing on Budget Allocation, Expenditure and Accountability and Transparency as it relates to RI.

Challenges Around Budget

• The resources available to the state to be shared are limited but request from MDAs are unlimited. Because every MDA believe is
• There is also the problem of generate and consume by some
• No dedicated budget lines for child and family health issue areas in the state budget
• Poor commitment by the stakeholders to releases to health programmes
• Non implementation of the CIPs for child and Family Health Issue areas
• In adequate envelopes to match the allocations to programmes in the SPHCDA

Recommendations

• High level advocacy visit to key stakeholders in Niger State on allocations and releases to SPHCDA & child and family health issue areas
• Dedicated budget lines for child and family health issue areas
• Reduction of donor dependence by the state government
• Increase commitment of stakeholders to providing sustainable domestic source of funding to child and family health issue areas
• Release of 15% support from Local Government Income to SPHCDA will go along way to strengthening SPHCDA & its services

Presentation on Routine Immunization

The State Immunization Officer – Dr Samuel Jiya presented on the “Overview of Routine Immunization: Status of RI Funding in Niger State” His presentation which was guided by a point dwells through Situation Analysis of RI, achievements, Challenges, Budget versus Releases. Partners support, opportunities and recommendations.

He started his presentation with a breakdown of statistics of Niger State and went further into current indices as relates to RI and later caped it up with RI funding schemes in Niger State

The summary of some indices given by the consultants as it relates to RI are as scaled out below:

(other details are in the presentation on RI attached)

• Infant Mortality rate is 70/1,000(MICS,2016)
• Under 5 mortality is 120/1,000(MICS,2016)
• Proportion of children fully immunized – only 80% of under -1 children had all basic vaccination for age
• Niger State has about 1, 543 health facilities and 1,123 (1104- public & 19-private) are offering immunization
• From immunization checklist, none (0%) of LGAs in the state received funds for its immunization activities and only 28% of private health facilities are providing RI
• No release of Funds budgeted in state’s budget for Immunization since 2016 to date
• Out of over 3,628 HTR communities only 578 covered with Immunization activities so far
• RI has a Costed Implementation Plan in Place to fund RI embedded into the State annual operational plan

• Potential Funding Sources for RI in Niger State :
  • State budgetary allocation (N116m/4years)
  • Partners’ financial support (N250m annually)
  • Basket funds – BMGF-MoU (N1.293bn)
  • BHCPF (Expecting =N1.5bn)
  • SOML PforR ($1.5m in year-1;
  • USD $1.2m year-2;
  • USD $ 6m year-3

Breakdown of Budget Allocation and Releases for RI in Niger State

S/No	Source	Budget	Release	Remarks
1	AOP	117.3 M		Proposed
2	State Budget (2019)	40 M	–	Approved in Budget
3	Saving One Million Lives (SOML)	100M	100 M
4	UNICEF IPDs	50M	50 M	RI fixed post & cold chain
5	Saving One Million Lives (SOML)	160M	160 M	30 solar Direct Drive SDDs Refrigerator procured
6	NPHCDA	50M	50M	Direct Payment to Push vendors
7	WHO	Estimated (50M)	Estimated (50M)	Capacity Building

Challenges:

• Non fulfilment of Abuja’s Governors commitment
• Lack of dedicated budget line for RI in the State Health budget
• Non release of funds to support RI by Niger State Government
• Lack of adequate funding for IPDs and RI activities by State and LGAs
• Non Implementation of CIP for RI in Niger State
• Difficulty in accessing numerous areas across many of the LGAs (HTR) particularly with the rainy
• Inadequate health workers to man health facilities in most LGAs
• Inadequate power supply in the State & LGAs cold stores
• Inadequate state led supportive supervision. Most of the supportive supervisions in 2018 were done by WHO and partners
• Inactive State and some LGAs Task force committee

Recommendations:

• Close Funding
• LGAs should support Routine Immunization Monthly.
• Intensify Monitoring & Supportive supervision at State/LGA
• Capacity building of the Routine Immunization
• Sanction of nonchalant Health
• Provision of Modern cold chain equipment at LGAs (refrigerators, freezers, solar freezers, generator and vaccines carriers).

Summarily from the interaction on RI funding In Niger State; it was submitted that there has been allocation to RI year in and year out but the allocation has not been backed up by any releases by the state Government to support RI activities in the state from 2015 to date. RI activities are largely being funded by partners in the state and also funds from SoML PfR programme under the care of the state. There also exists arrangement of basket funding with Niger State Ministry of Local Government, Ministry of Health and the state at large but it has not been implemented over the years under review. RI on the hand also have strong accountability platform through the emergence of SERICC

Day 02, 21st May 2019

Presentation on Family Planning:

This Desk Officer Family Planning of Niger State – Dorcas Abu (Mrs) who is the consultant on Family Planning took the stage on the second day of the meeting (21^st May 2019). Her presentation which was titled FP Situational Analysis dwell through structure and indices of Family Planning, FP budget allocation and releases, Partners and Intervention, main objectives of FP intervention in Niger state, Programme implementation and update, Trends of FP acceptors, CPR rates, human resource as well as FP service uptake in Niger State.

In her presentation, after relaying the FP indices, she gave an X-ray of budget allocation and releases to FP in Niger State from 2015 to date. The allocations as given by her are as follows:

• 2015-5 Million budgeted captured under general programs no approvals and Releases
• 2017-50 million budgeted and captured under Nutrition code and in Dec.2017 the sum of 2.1million was approved and release by SOML
• 2018-50M budgeted and captured under Nutrition code.8.9M was approved, and in Dec. 2018 the sum of N7.95M was approved and release by SOML
• 2019 -100M budgeted   and captured under Nutrition code.8.9M is been approved, proposal written awaiting

She thereafter talked about partners working on FP in Niger State, the objectives of FP in Niger State as well as the programmes implemented so far. She later capped up her presentations with discussions around challenges of FP implementation and some recommendations for the PAS partners

Summary from the presentation and interactions with the FP consultants on the update of FP, the Situation of Niger State FP is as summarized below

• Maternal Mortality ration is 576/100,000 lives birth (DHIS 2013)
• Infant Mortality rate is 70/1,000(MICS,2016)
• Under 5 mortality is 120/1,000(MICS,2016)
• Use of Modern Contraceptive is 6
• High unmet need of all women age 15 – 49 years (22.4%)
• Contraceptive prevalence rate (CPR) is (6.6%)
• Percentage of facilities providing FP services in Niger State is 41.5% as against the national percentage which is 4%
• Modern contraception use in the state; about 33.3% uses at least three modern methods of Family Planning in Niger State as against that of National average which is 4%, Traditional method 1%, any other method 6%
• No funding support to FP by Niger state government since 2015 except support from SOML in 2018
• Niger State have in place 5yr CIP through Support of Pathfinder Int but not being implemented
• In Niger State women have an average of seven (7) children each, and half of the population is under age fifteen (15) and thus will be entering child bearing age
• Survey data indicate that there is high unmet need of 22.4% for FP information and services.
• Nearly 1 in 6 (16%) married women ages from (15 to 49) will like to space or limit future birth but are not using any method of
• Contraceptive Prevalence Rate (CPR) is 9.2% (MICS 2017).
• Method of contraception use in the state: Modern method 4%, Traditional method 1%, any other method 1.6% (NDHS 2013).

Challenges of Family Planning Programming and funding

• There is no dedicated budget line in the State for FP
• Delay/non- release of budgeted funds
• Non implementation of CIP for FP
• Inadequate skilled service providers
• Full take up of Integrated last mile distribution model yet to begin
• Inadequate supply of consumables
• Poor Male involvement

Recommendations

• Advocate for timely release of funds for activities
• Push for a budget code for RI in Niger State
• Training of programme managers on work plan tracking
• More commitment on adherence to timelines
• Use of Ward Health Development Committees (WHDC), social mobilizers, CHIPS/CORPS to sensitize the hard to reach communities
• Advocating for more supervision and mentoring
• Service integration with LGA CCOs to transport commodities and consumables to service touch points
• Develop proposal based on AOP/Costed Implementation Plan (CIP) to address identified challenges

Summarily, from 2016 to date there has been allocations to FP in Niger State though lumped with Nutrition code, but no single releases have been made to the state FP unit to date. The Basic Health Care Provision Fund and Save One Million Lives Programmes in Niger State have components for provision for Family Planning. Their also exist a five year Costed Implemented Plan (CIP) for FP in Niger State which was developed and validated in January 2017 and further embedded into annual operational plan developed in December 2018, with no funding support and not being considered for appropriation in the state budget for FP. Also the state has not fully domesticated the National Policy on FP.

Presentation By PHCUOR Consultant:

The Former Director Planning Research and Statistics of State Primary Health Care Development Agency – Mohammed Yakatun Bida made a presentation on the Update of the level of Implementation of PHCUOR Policy in Niger State. His presentation started from the law establishing Niger State Primary Health Care Development Agency. He relayed that Niger State Primary Health Care Development Agency was established by law passed by the NGHA in December 2009. The proposed amendment was concluded in 2014 and Gazetted in July 2015. It has a management team, with clear lines of accountability, led by an Executive Director who reports to the Governor through its Honourable Commissioner for Health. The agency have 5 departments each headed by a Director and their Deputies deployed from Head of service, Ministries of Health, Local Government, Finance and Hospital management Board.

Mandate of Niger State PHCDA is “To deliver the most effective, efficient, qualitative, integrated and sustainable Primary Health Care Services that is available, acceptable, affordable and accessible with equitable distribution to the generality of the population of Niger State, particularly the Rural Population with their active involvement and participation and development of Community based system and functional infrastructure”.

Sources of Funding to SPHCDA

• State budgetary allocation (N116m/4years)
• Partners’ financial support (N250m)
• Basket funds – BMGF-MoU (N1.293bn)
  • BHCPF (1.5bn)
  • SOML P for R (USD, 1.5m yr1; USD 1.2m yr2);
  • USD 6M yr3

The consultant, thereafter, x-rayed the scorecards on PHCUOR so far produced, which according to him is the working document used to access the level of Implementation of PHCUOR in Nigeria. From his submission, he relayed that National scorecard III developed revealed that Niger state scored 61% overall in implementation of PHCUOR, ranking 6^th nationally and 1^st in the North Central geopolitical zone of Nigeria. The state scored high performance in Governance and Ownership domain (88%) and its lease performance in MSP domain (11%). He further relayed that following the scorecard 3 assessments on the Implementation of Primary Health Care Under One Roof in Nigeria which reveals some of the gaps on the level of PHCUOR Implementation in Niger State; topmost of which is the poor performance in the MSP domain with the score of 11%. Health Strategy Delivery Foundation (HSDF), one of the partners supporting working in Niger State supported the state to undertake the costing of MSP. This was thereafter followed by an independent assessment by HSDF on the implementation of PHCUOR in Niger State. This assessment which was conducted by HSDF reveals some challenges around Implementation of PHCUOR in Niger State as part of its findings. This according to him was followed by another National Assessment; Scorecard IV; Scorecard IV reveals that Niger State scored 73% in PHCUOR implementation placing Niger State in 2^nd position nationwide, that its best performing pillars include MSP 83%, Human Resources 83% and Office Setup 100% with good performance in other pillars.

Status of Niger STATE PHCUOR Pillars

S/No		Status	Remarks
1	Governance & Ownership	SPHCDA Board constituted
2	Legislation	PHCUOR bill was first passed into law since 2009. A new law repealing that of 2009 and establishing 2014 has been passed.	Gazzeted
3	Minimum Service Package (MSP)	Adopted the MSP but resources have not been mobilized for implementation. Health facilities and classified.	MSP Developed
4	Human Resources	There is inadequate qualified staff (Medical Officer of Health, Nurses / Midwifes, Community Health Extension Worker, Junior Community Health Extension Workers, Lab and Pharmacy technicians, Environmental Community Health Officers, E.T.C)	Staff Audit Ongoing
5	Repositioning	There is a formal orientation for managers to clearly understand their new roles and responsibilities at all levels	Job description done
6	Systems development	There is strategic and operational plan in place	Costed A.O. P
7	Operational Guidelines	Operational guidelines for PHCUOR not domesticated and used effectively.	Operation Guidelines for PHCUOR yet to be develop.
8	Office Setup	Well-furnished office space exists at the state and sub state levels for the Board	New Structure awarded
9	Funding structure and sources	The Agency has a budget line. There is council approval for Basket funding of the activities of the Agency which is yet to be operationalized.	State/BMGF/SO ML/BHCPF

However, in spite of the above report, Implementation of PHCUOR policy in Niger State from the interactions with the consultant still have some outstanding challenges. These challenges areas scaled out below:

Outstanding Challenges in PHCUOR Implementation in Niger State are

• Lack of effective functioning of the constituted board to Niger State Primary Health Care Development Agency
• Non transfer of Salaries and payment of PHC staffs across the LGAs from Ministry of Local Government and Chieftaincy Affairs to Niger State Primary Health Care Development Agency for effective Monitoring and coordination
• Nonexistence of Local Government Health Authority but existing 25 LGA structures are recognized as authorities
• On one functional PHC per ward, only 12 wards have functional PHCs out of 274 wards in Niger State
• Task shifting in Niger state is concerned as an interim measure, and will have to be mplemented alongside other efforts to increase the numbers of skilled health workers and this will ensure a true assessment and consider using existing health workers.
• Inadequate funding to SPHCDA from the State budget
• Lack of dedicated budget line for PHCUOR / PHC strengthening in the state budget
• Non fulfillment of 15% counterpart support from Ministry for Local Government and Chieftaincy Affairs to SPHCDA
• Inadequate HRH in the primary health care
• Poor state of physical infrastructures to support PHC system
• Low Community Participation
• Inadequate availability and supply of basic health commodities and other consumables at the PHC facilities
• Poor Referral System
• Inadequate funding of the primary health care system
• Fragmented health information system
• Poor management of financial resources allocated to primary health care programmes
• Poor quality perception of health services in primary health care facilities

Recommendations

• Budget line for PHC Strengthening and PHCUOR policy Implementation
• High level advocacies for release of 15% support from Local Government incomes to SPHCDA and transfer of salaries from Local Government to SPHCDA
• Regularization of the meetings of the Board to SPHCDA
• Recruitment of skill health workers e. g Nurses/Midwifes, Chews and Jchews, Pharmacy technicians, lab technicians e.t.c, to man the PHC facilities and encouragement of Task Shifting Policy
• Renovation of dilapidated PHC facilities across the state (SOML, BHCPF SDG, NG)
• Activation of WHDC, Community engagement strategy and Taskforce committees
• Provision of adequate supply of hospital consumables and commodities (SOML, SDG,DMA and Partners)
• Provision of tricycles ambulances at HTR
• Strengthening of SOML, Basket fund
• The need to centralized M&E system and Control room (State & LGA)
• Periodic auditing of account of SOML, BHCPF, BMGF and other sources of funding
• Encourage community participation in day to day activities of Primary Health care Facilities in collaboration with WHDC.

Day 03, 22nd May 2019

Presentation on Childhood Killer Diseases:

This was done by the former IMCI Desk Officer of Niger State – Elizabeth Jiya (Mrs). The consultant took the participants through the background information on CKD, rational for Integrated Management of Childhood Illness 1-3 (IMCI-1 to IMCI-3), overview of Niger State IMCI, cases of pneumonia and diarrhea. From her presentation, she relayed that Malaria, pneumonia; diarrhoea, measles, and malnutrition combine to cause high morbidity and mortality (70%) in the under-five population. Vaccine preventable diseases alone are responsible for 20% of infant mortality.

Through the interaction with the consultant, the following are the findings on the situational analysis Childhood Killer Diseases (CKD) in Niger State:

• Annual live birth = 195,000 of which 19,000 die before thier fifth (5th) birthday
• For every 1,000 live birth, 100 of them will die before they mark their 5^th birthday . This translate to one in every ten children in Niger state dying before they are aged five
• Both Pneumonia and Diarrhoea constitute both 12% of under 5 deaths in Niger State
• CIP in Place embedded into the state 5yr plan and not implemented
• No domestication of National policy on CKD with new addendum added in place to support CKD services in Niger State

Outstanding Challenges of Childhood Killer Diseases

• No budget allocation at both state and LGA levels, CKD activities are largely supported by donors
• No budget line for CKD in the state Health sector budget
• Non release of funds from state to support CKD activities in Niger State
• Stock out of ors/zinc and dispersible amoxycillin at both health facilities and community levels
• Poor data gathering
• Drop out of CORPs
• Very difficult terrain for regular supervision; many hard to reach communities (HTR)

Recommendations:

• Advocacies to strengthen political commitment of stakeholders
• Budget line for CKD activities; especially for Pneumonia and Diarrhea treatment
• Ownership by both state and LGAs to be less donor driven
• Efficient and effective releases to IMCI department
• Supportive supervision to ensure continuity
• Better quality data generation for analysis and planning

Summarily, Niger State has no any specific policy or budget line on CKDs (pneumonia & diarrhea). All childhood illnesses are categorized and budgeted under child health. CHAI has been training and supporting health workers on treatment guidelines and essential drug for the treatment of pneumonia & diarrhea, as well as supply of drugs in Niger State.

Outcomes

• Niger PAS partners knowledge strengthened on the project issue areas (FP, RI, CKD & PHCUOR)
• Niger State PAS partners knowledgeable about the issues around the project thematic focus
• Adequate information of Child and Family Health issue areas situations enough to support the production of issue briefs for the PAS project in Niger State known to Niger State PAS Partners
• Niger PAS Partners informed on budget allocation, approved and releases and the bottleneck and funding gaps of child and family health issue areas known to Niger State Pas partners
• Level of implementation of PHCUOR as well as PHC strengthening known and the outstanding challenges hindering PHCUOR policy Implementation known to PAS partners
• Relevant / Key advocacy targets to change the tide of child and family health issue area policy implementation and funding identified
• A sampled budget scorecard that can be adopted across project issue areas was shared
• First-hand information on allocations, approval and releases for child and family health issue areas for 2018 and 2019 received by Niger State PAS partners
• Consultants agreed to further partner with the team by providing any needed information and support in other to achieve the desired objective of the project

Key Recommendations

• Niger Partners to undertake a high-level advocacy to principal targets like the Executive Governor, the Speaker House of Assembly/House Committee on Appropriation, Hon Commissioners for Health, Finance, Planning and Local Government as well some other key influencers in the state
• Niger PAS Partners to produce strong advocacy support materials like issue briefs, press releases, fliers etc to support their advocacy course
• Intermittent advocacies to relevant stakeholders to strengthen political commitment of the stakeholders
• Sustainable domestic funding strategies to be created for child and family health issue areas to improve funding to child and family health issue
• Budget line for child and family health will foster effective funding to FP, RI, CKD and PHCUOR Implementation

Next Steps

• Niger State PAS Partners will do a desk review of the relevant documents collected to tease out situational analyses as well as other information’s that will further support the project
• The team will also use the information gathered to produce issue briefs to support the project
• The team will also develop concise advocacy messages from the issues to support advocacy course of the project

Agenda

Time	Activity	Responsibility
9:30 – 9:50am	Registration	All
9:50 – 10:00am	Prayers / Self-Introductions	All
10:00 – 11:00am	Presentation on the Update of Health Sector Budget of 2019 with focus on Child and Family Health Issue areas (FP, RI, CKD & PHCUOR)	Senior Planning Officer Budget – SPHCDA Abubakar Yanda
11:00 – 12:00pm	Question and Answer Session	All
12:00 – 1:00pm	Overview Of RI Policy Implementation and Domestic Funding Schemes In Niger State	State Immunization Officer Dr. Samuel Jiya
1:00 – 2:00pm	Comments, Question and Answer Session	All
2:00 – 2:20pm	Refreshment	All
2:20 – 2:30pm	Next Steps & Closure	All
1:20 – 1:25pm	Group Photographs/Departure	All

Photos