Nimba County Presentation

NIMBA COUNTY
BI-ANNUAL REVIEW
PRESENTER: DR. PAUL T. WHESSEH
SANNIQUELLIE, NIMBA COUNTY

OUTLINE OF PRESENTATION
1. County Geo-Demographic profile
2. Key achievements according to Pillars of health system:
•Governance and leadership
•Human Resources
•Service delivery
• finance
•Medical supplies and technology
•HMIS
3. Challenges/Constraints: Lessons learnt
4. Key deliverables for the next quarters
5. Recommendations

COUNTY GEO-DEMOGRAPHIC PROFILE
Map of Nimba
With Health Facilities

COUNTY GEO-DEMOGRAPHIC PROFILE: BACKGROUND
Nimba is one of the 15 counties of Liberia situated in the northern part of
the country. It is the second most populous county in Liberia with the
total population estimated at 508,663 (2012).
With the repatriation of refugees from the county, Nimba presently hosts
an estimated population of a bit over 8,500 Ivorian Citizens.
The county has borders with two neighboring countries (Cote d’Ivoire
and the Republic of Guinea). It also has common national borders with
five counties (Bong, River Cess, Sinoe, Grand Gedeh and Grand Bassa).
There are 6 health, 9 electoral, 12 education, 17 administrative districts
and 538 key communities.
There were 63 health facilities opened to the public but 62 are functional
at present (5 hospitals, 5 health centers and 52 PHC clinics).
Of the 62 health facilities, 39 (63%) are being supported by NGOs
(Africare) with 56 (89%) conducting EPI activities.

COUNTY GEO-DEMOGRAPHIC PROFILE:
DISTRICT POPULATION, NUMBER OF HEALTH FACILITIES (2012)
Districts
Total County
Population (2012)
SANNNIQUELLIE MAHN 141,627 15
GBEY GEH 77,884 10
ZOE GEH 84,856 10
SACLEPEA 87,459 13
TAPPITTA 82,597 11
YARWIN MENSONNON 31,241 3
Number of Health
Facilities
Total 508663 62

COUNTY GEO-DEMOGRAPHIC PROFILE:
SKILL STAFF PER POPULATION INCLUDE GCHVS, TTMS
(2012)
Skill Staff
Present
Available
Number
Population
(2012)
Medical Doctor 18 508,663
Registered Nurses 179 508,663
Certified Midwives 42 508,663
RN/CM 1 508,663
LPN 7 508,663
Lab. Tech 33 508,663
X-Ray Tech 7 508,663
gCHVs 1210 508,663
TTM 2901 508,663
Others 159 508,663
Ratio per
Population
1:28259
1:2842
1:12111
1:508663
1:72666
1:15414
1:72666
1:420
1:175
1:3199

KEY ACHIEVEMENTS: GOVERNANCE AND LEADERSHIP
Key Activities planned Implementation
status
Reactivate and reconstitute the NCHSW and
G. W. Harley Hospital Boards
Obtain copy of the TOR of Board and
distribute to all members
Regularize the NCHSW and GWHH board
meetings
To regularly attend county development
steering committee meeting
Fully achieved
Fully achieved
Comment
Partially achieved CHO and County Development
Superintendent are often out of the
county attending meetings thereby
interfering planned meetings at the
county.
Fully achieved
Conduct regular CHT coordination meeting Partially achieved Deplorable and inaccessible road
Conduct quarterly PBF review meeting with Partially achieved
conditions due to season constraints
Overlapping activities
Central MOHSW & IPs and provide
feedback to all stakeholders.

KEY ACHIEVEMENTS: HUMAN RESOURCES
Key Activities planned Implementation
status
Comment
Conduct staff capacity mapping Not achieved Training needs assessment
is ongoing to provide
baseline.
Develop staff capacity building plan
in consultation with Central
MOHSW
Develop a system and structure of
performance appraisal.
Provide TOR for all staff Fully achieved
Conduct staff verification/inventory
at all levels
Not achieved County needs baseline to
develop capacity building
plan.
Partially achieved Awaiting technical support
from MOHSW
Fully achieved

KEY ACHIEVEMENTS: HUMAN RESOURCES
Key Activities planned Implementation
status
Comment
Recruit appropriate staff to fill in HR gap Partially achieved Difficulty in getting recruited
at county
staff on GOL payroll.
Distribute Human Resources based on the Partially achieved Ongoing process that cannot
existing workload (EPHS flexible
be fully achieved in a period of
staffing)
time
Award annual leave to all staff based on
Civil Service Policy
Fully achieved
Mandate all staff to wear appropriate
uniform while on duty
fully achieved Ongoing process

KEY ACHIEVEMENTS: SERVICE DELIVERY
Key Activities planned Implementation status Comment
Total malaria cases (under 5 and above
5)
Total malaria cases diagnosed by RDT
and Microscope test.
Total malaria cases diagnosed
Clinically.
Total number of children 5 with
Malaria Treated with ACT
Total # of children with malaria treated
with ACT within 24 hours
Q1
Jan-
Mar
2012
Malaria
Q2
Apr-
Jun
2012
Q3
Jul-
Sept
2012
Q4
Oct-
Dec
2012
41718 59009 60037 49506
22950 36835 35621 28905
18768
22175 24416 20601
18415 27088 28295 22547
16320 23758 24357 20596
3771 5825 5563 7184

KEY ACHIEVEMENTS: SERVICE DELIVERY
Key Activities planned Implementation status Comment
New Smear Positive TB patients tested
for HIV before or during treatment-(Coinfection)
New Smear Positive patients who are
HIV positive-(Co-infection)
TB Patients whose treatment was
interrupted for 2 consecutive months or
more-(DEFAULTED)
The sum of patients cured and those who
have completed(TREATMENT SUCCESS)
Q1
Jan-
Mar
2012
TB/HIV
Q2
Apr-
Jun
2012
Q3
Jul-
Sept
2012
Q4
Oct-
Dec
2012
90 57 54 76
7 6 6 6
16 11 6 0
110 57 52 7

KEY ACHIEVEMENTS: SERVICE DELIVERY
Key Activities planned Implementation status Comment
Pregnant women pre-and post-test
counseled and received test result.
Q1
Jan-
Mar
2012
Q2
Apr-
Jun
2012
HIV/AIDS (PMTCT)
4361
Pregnant women tested positive for HIV 44
HIV + Pregnant Women initiated on
Cotrimoxazole prophylaxis
33
HIV + Pregnant Women initiated on ARV 17
Q3
Jul-
Sept
2012
Q4
Oct-
Dec
2012
5268 5390
38
4633
37
39
17
12
21
13
28
23

KEY ACHIEVEMENTS: MEDICAL SUPPLIES AND TECHNOLOGY
Key Activities planned Implementation
status
Liaise with Central MOHSW to procure
supply chain management guidelines for
the county
Distribute supply chain management
guidelines to all HFs Fully achieved
Through supportive supervision, ensure
the proper usage of the supply chain
manual.
Fully achieved
Train CHSWT supervisors, DHOs &
relevant HF staff in rational use of drug
protocol & record keeping
Procure and distributive national
therapeutic guideline to all health
facilities
Comment
Partially achieved Updated version has been
produced but not yet available
in county.
Fully achieved
Fully achieved
Only the old version in use

KEY ACHIEVEMENTS: MEDICAL SUPPLIES AND TECHNOLOGY
Key Activities planned Implementation
status
Review and cross check all drugs
Tracking document (stock book, BIN
card, internal requisition and patient
charts) on each supervisory visit.
Conduct monthly supportive
supervisions at all HFs on drugs
management
Distribute monthly drugs & medical
supplies.
Integrate monthly drugs
consumption reports collection with
HMIS reports .
Fully achieved
Comment
Partially achieved Supportive supervision is
done monthly at selected
facility based on the number
and geographic locations of
these health facilities.
Fully achieved
Fully achieved

KEY ACHIEVEMENTS: MEDICAL SUPPLIES AND TECHNOLOGY
Key Activities planned Implementation
status
Conduct training for relevant staff in
using of the upgraded LMIS
software
Comment
Not achieved Upgraded LMIS software
not yet available at the
county; currently using
spread sheets.

KEY ACHIEVEMENTS: FINANCE
Key Activities planned Implementation
status
Liaise with Central MOHSW to
transition from paper based
accounting
accounting
to computer based
Comment
Not achieved Computers still
lacking,Training on going
for financial staff.
Write and submit a monthly financial
report and disseminate copies to
members of the CHSWT
Not achieved Modified for financial report
to be discussed quarterly
with management team.
Conduct quarterly internal audit Not achieved Activity was modified to
annual internal audit- Q4
Develop county budget based on Fully achieved
activities and submit to Central
MOHSW for budgetary allocation
Disseminate results of internal audit
to members of the NCHSWT
Not achieved Internal audit is not yet
organized.

KEY ACHIEVEMENTS: FINANCE
Key Activities planned Implementation
status
Conduct training for CHSWT staff
on financial management SOPs Partially achieved
Review work plan & readjust activities
based on budget allocated Partially achieved.
Comment
Orientation was conducted
for CHT members. No fund
available

COUNTY ACHIEVEMENTS TOWARDS CORE
TARGETS/INDICATORS
Indicator Description Baseline
January -
June 2012
Current
Status
July-Dec
2012
Population 508,663 508,663
OPD Consultation per inhabitant
Deliveries conducted at facilities by Skilled Health
Personnel.
Couples year of Protection(CYP)
IPT 2 dose (3 rd Trimester)
288,787 290,631
6,731
4,543 9,036
7,542
6,664
6,033
Reasons for Nonachievement
Target at 80% is
9156 but achieved
6664 which is 73%
of the target
Stock out of IPT

COUNTY ACHIEVEMENTS TOWARDS CORE
TARGETS/INDICATORS
Indicator Description Baseline
January to June
2012
ANC 4 th Visits 8,675
Current Status
July to December
2012
8,939
Penta 3 10,113 9,747
Percent(%) of Facilities
Reporting
Percent(%) of Facilities
Reporting on time
100% 100%
87%
Reasons for Nonachievement
Bad road conduction
during the raining
season

CHALLENGES/CONSTRAINTS/
LESSONS LEARNT.
CHALLENGES/CONSTRAINTS:
Irregular and inadequate supply of drugs and medical
supplies from NDS.
HR gaps especially CMs and doctors at county hospital.
Delayed placement on GOL payroll/incentive for
Professional staff
recruited.

CHALLENGES/CONSTRAINTS/
LESSONS LEARNT.
CHALLENGES/CONSTRAINTS:
Limited vehicles and persistent breakdown of old
vehicles including the “ smooth terrain” Supply chain
vehicle.
Inadequate and delayed funding from GOL; for example,
Quarter 3 allotment has not been received coupled with the
recent sad news that allotment will be cut by 20%.

RECOMMENDATIONS
Supply drugs and medical commodities based on
consumption reports from the counties.
Placement of staff on GOL payroll/incentive with in a
reasonable time frame- 2 months.
Recruit two(2) additional Doctors for the County hospital.
MOU with Esther Bacon School of Nursing/MOHSW to
assign CM to Nimba Co.- Quota needed for students from
North and Central Liberia.
Speed up the relocation of G. W. Harley Hospital which is
the first Government Referral Hosp for Nimba Co.
MOHSW Central to routinely include the supply of vehicles
to the counties as part of their budget rather than asking
counties to purchase vehicle from their GOL “allotment.”

KEY DELIVERABLES FOR QUARTERS
3 AND 4.
Regularize the NCHSW and GWHH board meetings
Train the County Supervisors and DHOs on performance
appraisal.
Conduct performance appraisal for all staff.
Conduct PBF training for all DHOs and County Supervisors
Develop staff capacity building plan in consultation with
central MOHSW and Partner.
Continuous recruitment of appropriate staff to fill in the HR
gap.

KEY DELIVERABLES FOR QUARTERS
3 AND 4.
Renovate the community initiated building in Glahn Town,
Tappita district to serve as clinic
Conduct county quarterly review meeting
Conduct training on community integrated HMIS tools and
supervision guide.
Purchase one vehicle for drugs and medical supply
Conduct training in IMNCI in the nine GOL facilities
Provide training for service providers and communities on FP
activities
Increase PMTCT site from 30 to 35

Thank You