PATHS Final programme report: "Togetherness in Health" the Enugu ...
PATHS Final programme report: "Togetherness in Health" the Enugu ... PATHS Final programme report: "Togetherness in Health" the Enugu ...
PATHS ApproachEngagement Process with State GovernmentGiven the poor state of the public sector, the programme’s initial focus was to work actively with theState Government, particularly the Ministry of Health, although other Ministries such as Finance,Women’s Affairs and Social Development and Ministry of Economic Planning andFinance were also actively involved in key initiatives at various points.In an effort to ensure that the engagement process was supportive and collaborative, in 2002 PATHSrequested that the Health Commissioner establish an inception phase Committee with representationfrom across the SMoH. The purpose of the Committee was to lead and guide the direction of thePATHS interventions. Following an inception phase review of PATHS in late 2003, the inception phaseCommittee was dissolved and a PATHS Steering Committee was established with an expandedmembership to include NGO and private sector representation.Despite the best of intentions, the committee was slow to demonstrate leadership of the varioushealth reform initiatives underway within the state. In an effort to resolve this, four sub committees,linked to the PATHS themes, were introduced in 2005 enabling broader engagement of stakeholderswith specific expertise. Each sub committee was chaired by a member of the Steering Committee.Despite concerted efforts by PATHS, these committees met infrequently, and when they did,attendance was poor. Following discussion with the Health Commissioner a decision was made toreconstitute the Steering Committee as a State Planning and Co-ordinating Committee. The idea wasthat the Committee would play a proactive role in managing not only the PATHS supported initiatives,but also play a leadership role on behalf of the SMoH in relation to other donor health programmes,thereby ensuring greater co-ordination and integration. Ensuring that this important Committeecontinues to operate effectively is a key challenge for the future.Increasing Stakeholder OwnershipThe state-wide focus of the District Health System meant that PATHS provided support across all 17Local Government Authorities (LGAs), the seven constituted District Health Boards (DHBs) and, from2005 onwards, 56 Local Health Authorities (LHAs). As the District Health System became increasinglymore established the emphasis shifted to direct management of the different reform initiatives bythe seven Districts. This included initiatives such as Peer and Participatory Rapid Health Appraisalfor Action (PPRHAA), integrated supportive supervision (ISS), business planning and interpersonalcommunications skills training for health providers (IPCC). The DHS provided the flexibility for differentdistricts to undertake different activities in line with their respective business plans, which, in turn,reflected locally identified health needs.Over the period 2006-2008, individual stakeholders took increasing ownership of many of the PATHSsupported initiatives which they led and managed.20 PATHS Final Programme Report
Engagement with Other Development Partnersand the Private SectorAlongside the support for public sector reform initiatives, PATHS worked increasingly (from 2005onwards) with six faith-based hospitals and a selection of their primary care facilities, as well as sevenNGOs (one per district) and a number of CBOs.Early linkages with German Leprosy Relief Agency (GLRA) were established to support thestrengthening of TB services, in particular by the provision of motorbikes for 17 Tuberculosis andLeprosy (TBL) supervisors; improved signage for facilities providing TB/DOTS services; and capacitybuilding of laboratory staff in a number of laboratories providing TB services.Links with UNICEF were established aroundthe provision of immunisation servicesand by providing support for a limitednumber of LGAs to strengthen their focuson key household practices for IntegratedManagement of Childhood Illnesses (IMCI).PATHS also worked closely with three of theother DFID funded programmes in the State:the State and Local Government Programme(SLGP) on the development of Ministry ofHealth budget and plans; StrengtheningNigeria’s Response to HIV/AIDS (SNR) incommunity mobilisation; and the HealthCommodities Procurement (HCP) projectwhich provided drugs and equipment forhealth facilities across the state.Development Partners operating inhealth in Enugu :World Bank (HSDPII), German Leprosy ReliefAgency (GLRA), WHO, UNICEF, Action Aid.DFID programmesState and Local Government Programme (SLGP)Strengthening Nigeria’s Response to HIV/AIDS(SNR)Health Commodities Procurement Project (HCP)As the World Bank funded Health Systems Development Programme (HSDPII) was also providing anumber of facilities with drugs and equipment it was essential to link with the programme in order toprevent duplication. This proved challenging for a number of reasons.PATHS was also a member of the Contact Officers Group (COG) which brought together theCommissioners of key line Ministries with representatives of the DFID programmes. The aim of theforum was to ensure collaboration and co-ordination of effort across the State. The chair was sharedbetween the Secretary to the State Government and the DFID Regional Co-ordinator. In early 2008 aset of key performance indicators for the COG were agreed, with members expected to monitor theirperformance against the indicators on a regular basis.Systems StrengtheningA key focus of the PATHS programme in Enugu was to strengthen the underpinning systems foreffective implementation of the District Health System management structure and to produce aframework to enable effective engagement and joined up thinking amongst a wide range of healthstakeholders (see Section 3 for more detail).“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 21
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Engagement with O<strong>the</strong>r Development Partnersand <strong>the</strong> Private SectorAlongside <strong>the</strong> support for public sector reform <strong>in</strong>itiatives, <strong>PATHS</strong> worked <strong>in</strong>creas<strong>in</strong>gly (from 2005onwards) with six faith-based hospitals and a selection of <strong>the</strong>ir primary care facilities, as well as sevenNGOs (one per district) and a number of CBOs.Early l<strong>in</strong>kages with German Leprosy Relief Agency (GLRA) were established to support <strong>the</strong>streng<strong>the</strong>n<strong>in</strong>g of TB services, <strong>in</strong> particular by <strong>the</strong> provision of motorbikes for 17 Tuberculosis andLeprosy (TBL) supervisors; improved signage for facilities provid<strong>in</strong>g TB/DOTS services; and capacitybuild<strong>in</strong>g of laboratory staff <strong>in</strong> a number of laboratories provid<strong>in</strong>g TB services.L<strong>in</strong>ks with UNICEF were established around<strong>the</strong> provision of immunisation servicesand by provid<strong>in</strong>g support for a limitednumber of LGAs to streng<strong>the</strong>n <strong>the</strong>ir focuson key household practices for IntegratedManagement of Childhood Illnesses (IMCI).<strong>PATHS</strong> also worked closely with three of <strong>the</strong>o<strong>the</strong>r DFID funded <strong>programme</strong>s <strong>in</strong> <strong>the</strong> State:<strong>the</strong> State and Local Government Programme(SLGP) on <strong>the</strong> development of M<strong>in</strong>istry ofHealth budget and plans; Streng<strong>the</strong>n<strong>in</strong>gNigeria’s Response to HIV/AIDS (SNR) <strong>in</strong>community mobilisation; and <strong>the</strong> HealthCommodities Procurement (HCP) projectwhich provided drugs and equipment forhealth facilities across <strong>the</strong> state.Development Partners operat<strong>in</strong>g <strong>in</strong>health <strong>in</strong> <strong>Enugu</strong> :World Bank (HSDPII), German Leprosy ReliefAgency (GLRA), WHO, UNICEF, Action Aid.DFID <strong>programme</strong>sState and Local Government Programme (SLGP)Streng<strong>the</strong>n<strong>in</strong>g Nigeria’s Response to HIV/AIDS(SNR)Health Commodities Procurement Project (HCP)As <strong>the</strong> World Bank funded Health Systems Development Programme (HSDPII) was also provid<strong>in</strong>g anumber of facilities with drugs and equipment it was essential to l<strong>in</strong>k with <strong>the</strong> <strong>programme</strong> <strong>in</strong> order toprevent duplication. This proved challeng<strong>in</strong>g for a number of reasons.<strong>PATHS</strong> was also a member of <strong>the</strong> Contact Officers Group (COG) which brought toge<strong>the</strong>r <strong>the</strong>Commissioners of key l<strong>in</strong>e M<strong>in</strong>istries with representatives of <strong>the</strong> DFID <strong>programme</strong>s. The aim of <strong>the</strong>forum was to ensure collaboration and co-ord<strong>in</strong>ation of effort across <strong>the</strong> State. The chair was sharedbetween <strong>the</strong> Secretary to <strong>the</strong> State Government and <strong>the</strong> DFID Regional Co-ord<strong>in</strong>ator. In early 2008 aset of key performance <strong>in</strong>dicators for <strong>the</strong> COG were agreed, with members expected to monitor <strong>the</strong>irperformance aga<strong>in</strong>st <strong>the</strong> <strong>in</strong>dicators on a regular basis.Systems Streng<strong>the</strong>n<strong>in</strong>gA key focus of <strong>the</strong> <strong>PATHS</strong> <strong>programme</strong> <strong>in</strong> <strong>Enugu</strong> was to streng<strong>the</strong>n <strong>the</strong> underp<strong>in</strong>n<strong>in</strong>g systems foreffective implementation of <strong>the</strong> District Health System management structure and to produce aframework to enable effective engagement and jo<strong>in</strong>ed up th<strong>in</strong>k<strong>in</strong>g amongst a wide range of healthstakeholders (see Section 3 for more detail).“<strong>Toge<strong>the</strong>rness</strong> <strong>in</strong> Health” <strong>the</strong> <strong>Enugu</strong> Experience <strong>in</strong> Health Sector Reform, 2002-2008 21
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