Although there are evidences of significant progress in the Implementation of the Primary Healthcare Under One Roof policy in the 4 PAS focal states of Kano, Kaduna, Niger and Lagos states, inclusiveness, poor management roles, consolidation of staff to State Primary Healthcare Development Agencies (SPHCDAs) and absence of costed Minimum Service Packages are some of the identified advocacy issues according to a dRPC-PAS findings in 2020.
In Kaduna state, there is significant progress in the implementation of primary health care under one roof (PHCUOR) policy reform in the state. The state coming with 5th position scored 66% in the PHCUOR scorecard 4 assessment conducted in 2018 placing. The State Primary Health Care Board (SPHCB) has a governing board, management team and a clear line of accountability reporting through the honorable commissioner for health. The board was established by law and has a costed and approved minimum service package document with investment /service delivery plan. Although, theses service costed package was not captured in the state annual budget. In essence, the family planning, maternal child health, nutrition programs and staff in the state ministry of health (SMOH) have all been moved to the SPHCB as part of re-positioning.
The state has developed it key strategic documents such as the Strategic Health Development Plan (SHDP), State and Local Government Health Authority (LGHA) annual operational plan, Integrated Supportive supervision (ISS) checklist with the list of the ISS team composition including state and LGHA members and supervisory schedule. With a performance review of SPHCB has been conducted 2016, it is pertinent to know that Kaduna state has a functional data quality assurance system and it conducted a state wide Data Quality Assurance (DQA) in 2017, the state Health Management Information System (HMIS) facility reporting rate in 2018 is >80%.
The SPHCB in compliance with the implementation guidelines for PHCUOR policy reform conducted orientation to familiarize staff at all levels with the mandate of the board and has also produce administrative manual to standardized the administration process in the SPHCB. Under the Human resource pillar, the state has moved all staff of PHC in the LGAs, SMOLG, LGSC, to the SPHCB, staff nominal roll develop with job description and position for all the SPHCB and LGHA staff.
The SPHCB has a dedicated budget line and bank account and all staff of the board are on it payroll. The SPHCB ensured that the LGHA also have dedicated banks for running of it operations. PHC budget performance is periodically tracked and annual audit of the PHC income and expenditure is conducted. The SPHCB has a physical office set up with requisite amenities and equipment such as power, water, computers, furniture, internet access and printer.
Kaduna State Area for improvement: Include women and key stakeholders needs to be included in the composition of the governing board. SPHCB law should be amended to delineate roles and responsibilities of the governing board from that of the management team and also to reflect clear oversight function of State Ministry of health (SMOH) on the SPHCB. The state also needs to develop regulations for the operationalization of the SPHCB; transfer malaria, HIV/AIDs and TBL programs to the SPHCB. It is also important to conduct at least two performance review of the PHC annual operational plan per annum, improve HMIS facility reporting rate of >80%, and provide regular funding for health facilities to cover operational expenses (cost).
Kano state: has made tremendous efforts in the implementation of the PHCUOR policy reform. This was eminent in the 2018 PHCUOR scorecard 4 assessment were the state scored 63% and placed in 8th position nationwide. The SPHCB is headed by a substantive Executive Secretary (EX) with it management team in place, the government has recently constituted a governing board for the SPHCB on the 5th February 2020 This was made possible by PAS coalition advocacy visit to the governor on the 6th August, 2019 requesting for the governor to constitute the SPHCB governing board, Kano State also have the ward development committee (WDC) in place.
For legislation the state has a law backing the establishment of the SPHCB and regulations for the operationalization of the law, costed and approved minimum service package (MSP) document as part of the requirements.
Repositioning: only immunization programs has been moved to the SPHCB under system development. The state has developed it Strategic Health Development Plan (SHDP), state and LGA PHC annual operational plan, M&E result performance framework with clear milestones and target, ISS checklist and the list of the ISS team composition including state and LGA members, and supervisory schedule. The state has also conducted one performance review on the SPHCB in the past years. The state has functional data quality assurance system in place and conducted data quality assurance in 2017. The reporting rate of HMIS facility is >80%.
All SPHCB staff has been moved to the board, but the SPHCB staff are not on the board payroll, the SPHCB has a dedicated budget line and bank account, the state is yet to develop it operational guidelines.
Office set up: the SPHCB has an office fully functional with all the required amenities in place
Area for improvement: Amend the SPHCB law to make provisions for the movements PHCs department, programs and staff in the SMOH, SMOLG, and all LGA to the SPHCB, transfer all PHC programs including malaria, HIV/AIDs, TBL, FP/MCH/Nutrition to the SPHCB, develop functional HRIS to support the HRH strategic plan, include all PHC staff in the payroll of SPHCB and develop the SPHCB operational guidelines.
Niger state has been active in the implementation of PHCUOR policy reform, in the 2014 the state came second in the PHCUOR scorecard 4 assessment conducted by NPHCDA and partners scoring 73% in the PHCUOR policy reform implementation. Niger SPHCB has a governing board and management team in place. The Niger State PHCB is established by law and gazette. The state has no costed and approved minimum service document.
PHC programs such as FP, MCH, Nutrition and immunization, and staff in the SMOH have been move to the SPHCB. The state has developed it strategic health development plan, ISS checklist, ISS team including the state and LGA, supervisory schedule and conducted performance review on the SPHCB in 2017.
The state has a functional data quality assurance system and has conducted the state-wide data quality assurance in 2017, it HMIS facility reporting rate in the last 12 months is >80%. All PHC staff in the LGAs SMOLG and LGSC have been move to the SPHCB and on boarded, with job description and position for all SPHCB staff and the SPHCB also has staff nominal roll.
The SPHCB has a dedicated bank and all it staff are on it payroll. Periodic PHC budget performance review tracked and annual audit of the PHC income and expenditures for the preceding year conducted. The state has an administrative manual which was aimed to standardize the administrative processes in the SPHCB. The SPHCB also has a physical office with all the office amenities complete like internet access, furniture, power, water, computer and printer.
Area of improvement: lncludes women and all key stakeholders in the governing board as recommended in the national guidelines, establish LGHA in all 25 LGAs of the state; amend the SPHCB law to reflect clear oversight functions of the SMOH on the SPHCB. It must develop a costed MSP documents for PHC facilities, transfer Malaria, HIV/AIDs and TBL programs to the SPHCB, Develop PHC manual operational plan incorporating the LGA PHC. It also need to develop functional HRIS to guide HRH strategic plan, establish dedicated budget line for PHC in the state Annual budget, provide regularly operational cost to PHC for integrated services delivery and must also conduct SPHCB wide-orientation to familiarize staff at all levels with the mandate of the SPHCB.