PATHS Final programme report: "Togetherness in Health" the Enugu ...

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Health Board and the Districts. The LHAs’ knowledge and understanding of their “patch” was greatlystrengthened by the introduction of a quarterly review process. This commenced in 2006, and theprocess was chaired by the Permanent Secretary of the SMOH with support from the Ministry of LocalGovernment and the Local Government Service Commission.Despite the positive developments, by early 2008 there is still a considerable way to go before it couldbe said that the District Health System was functioning in its entirety. Such wide-ranging fundamentalchange takes time to take root.The LHAs quarterly review process brings together the Permanent Secretary (PS) SMoH asChair; PS, Ministry of Local Government; PS, Local Government Services Commission andrepresentatives of the State Health Board as the review panel. The LHAs report against an agreedreport format on all the happenings in their respective LHAs for the three month review period.A set of indicators has been developed and each LHA is scored against the indicators. If an LHAremains at the lowest score possible on more than three occasions then the LHA ExecutiveSecretary is removed. The respective DHB members are expected to be in attendance and canbe held acountable for the poor performance of their LHAs.Agbani District HealthBoard Members“How effectively can you implement adecision that you were not part of? That wasour fate before the DHS. Today you met usin a meeting of the Agbani District HealthBoard. We review issues and exchange ideaswith our bosses for the betterment of thewhole system. This communication systemhas improved so many things that have ledto better service delivery and also improvedthe quality of care.”Mrs Nnaji, LHA Executive Secretary“But when PATHS came, the numerouscapacity building trainings they gave usopened a new page in our approach tohospital management; in terms of personnel,management of drugs, equipment andfinances, client/staff relationships, generalplanning and resource management. Infact, DHS has given me a broader view andinsight on how to manage both human andmaterial resources.”Dr Enih, CEO Agbani DHB28 PATHS Final Programme Report
Development of anSMoH Health StrategyAll activities undertaken by theMinistry of Health should beunderpinned by a State HealthStrategy. Enugu had a state healthplan which was due to end in2006. Thus it seemed appropriate,particularly with the advent of theDistrict Health System, to developa State Strategy for Health. Theidea was that this would form thelink between the Federal and Statepoverty reduction strategies (NEEDSand SEEDS respectively) and theSMoH business plan.The purposes of the strategy were:International Health policy(Millennium Development Goals)Federal Government NEEDS(Reflecting international requirements e.g. MDGs)Enugu State SEEDS(Reflecting DHS & NEEDS requirements + MDGs)Health Strategy - MoH(Reflecting DHS & SEEDS requirements + MDGs)••to support and provide aframework for the current andBusiness Plan - MoHfuture health systems reform(Including SHB/LHA business plans)processes as enunciated in theEnugu State Health Law 2005 andthe SEEDS documentFacility Business Plansto drive health delivery atDistrict, Local Government andcommunity levels within the context of social development issues prioritized in the State’s PovertyReduction Strategy document.The strategic health planning initiative began in 2005. The intention was that this process wouldprovide an ideal opportunity for PDPD, within their revised remit under the DHS, to demonstrateleadership of the policy development process. However, despite the provision of considerableinternational and regional consultancy support, progress was not as rapid as had been hoped, partlydue to poor capacity within PDPD. In late 2005 a concept note was produced as a way of deepeningstakeholders’ understanding of the strategic development process. The concept note proposed thatthe health strategy should cover the period 2006 to 2010 and that the development process beparticipatory and driven by PDPD.The following steps were recommended••••Undertaking a Situational AnalysisDissemination of study findings and widespread discussion, and consensus building amongstakeholdersDrafting the Health Strategy and submission for state approvalDissemination of the content of the strategy and preparing for its launchFurther work in early 2006 produced a very early draft outline. However, a change in circumstanceswithin the PATHS programme left further development on the back burner until mid-2007. In 2007“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 29
Page 3 and 4: "Togetherness in Health"the Enugu E
Page 5 and 6: FORWARDI am very pleased on behalf
Page 8 and 9: 6 PATHS Final Programme Report
Page 11 and 12: Section 1:Setting the Enugu Context
Page 13 and 14: KEY FACTSHealth Indices: Comparison
Page 15 and 16: PHC centres and cottage hospitals i
Page 17 and 18: Section 2:Overview of the PATHSProg
Page 19: Stakeholder initiatives supported b
Page 22 and 23: PATHS ApproachEngagement Process wi
Page 24 and 25: Pro-poor FocusPATHS pro-poor focus
Page 26 and 27: “PATHS has indeed impacted very p
Page 28 and 29: the 56 Executive Secretaries of Loc
Page 32 and 33: it was agreed that the original ide
Page 34 and 35: •••Working to an agreed timef
Page 36 and 37: PATHS provided much of the infrastr
Page 38 and 39: to access for the Ministry of Healt
Page 40 and 41: and the core DRF models used in oth
Page 42 and 43: Enabling Service DeliveryDeveloping
Page 44 and 45: Procurement of Drugs and EquipmentT
Page 46 and 47: equired in order to ensure that mor
Page 48 and 49: Training in the laboratory of Annun
Page 50 and 51: The services to be delivered were a
Page 52 and 53: Where care is givenEnugu’s health
Page 54 and 55: Enugu State Total Deliveries in Pub
Page 56 and 57: The selection process resulted in t
Page 58 and 59: Reduced maternal andinfant mortalit
Page 60 and 61: By the conclusion of the second ser
Page 62 and 63: With the advent of the DHS it was a
Page 64 and 65: Inter-Personal Communication and Co
Page 68 and 69: Intermediate Outputs1) The DHS stru
Page 70 and 71: 5) A culture of business planning a
Page 74 and 75: 4) The tendency for politicians to
Page 76 and 77: Abbreviations and AcronymsANCBCCBEO
Page 78 and 79: AcknowledgementsThe PATHS programme
Page 80 and 81:
Master trainersSMoH/faith based sec
Page 82:
80 PATHS Final Programme Report
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