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

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Where care is givenEnugu’s health system has five different levels of public health facilities, namely: health post,health clinic, health centre, cottage hospital and district hospital. In addition there are a largenumber of varying sized private and faith-based facilities. The packages of care distinguishbetween primary facilities, covering the health post, health clinic, health centre and secondaryfacilities, covering cottage hospital and district hospital.Care providers* * *A number of professional and non-professional staff were assigned roles in the packages,including:DoctorsNursesMidwivesPublic Health NursesPharmacists and Pharmacy TechniciansRadiographers and Radiography TechniciansLaboratory Scientists and Laboratory Technicians Community Health OfficersCommunity Health Extension WorkersEnvironmental Health OfficersRecords OfficersIn September 2005, 36 master trainers were trained, of whom 18 were given responsibility foroverseeing the roll-out to facilities. The medical packages of care were introduced in 2005 and thesurgical packages in 2006. By early 2008, 1,040 people had been trained in their use. It is anticipatedthat additional staff will be trained prior to completion of the programme.Improved Management of Emergency Obstetric CareActivity in this area focused on:••Training of doctors, nurses and CHEWs in life-saving skillsOrientation of TBAs to danger signs and the need for prompt referral• Development of a contracting mechanism through faith-based hospitals for provision ofEmergency Obstetric Care for the public sector• Provision of equipment to both public and faith-based facilitiesTraining in Life Saving Skills (LSS)Given the need to work towards reducing maternal mortality, a reproductive health scoping missionwas undertaken in late 2003 to determine the target issues for the state. In April 2005 a furtherneeds assessment confirmed that one focus should be the provision of life saving skills for doctors,nurses and CHEWS. As a result, 12 doctors and 16 nurses were trained as master trainers in December2005 and February 2006 respectively. The facilities to be used for training purposes were agreedbased on their number of deliveries. This helped to ensure that the participants would benefit fromcompetency-based training. Both public and faith-based facilities were involved in the training.50 PATHS Final Programme Report
Training of facility staff began in February 2006 with expanded life saving skills (ELSS) for medical staff,life saving skills (LSS) for nurses and midwives and modified life saving skills (MLSS) for CHEWS. Byearly 2008, 32 doctors, 178 nurses and 171 CHEWS had been trained.Initially, training participants were drawn from the six district hospitals and 56 Early Bird Clinics, allof which had by then been provided with both drugs and basic equipment. However, given that thebulk of deliveries in Enugu took place in the private/faith-based sector, staff from these facilities wereincluded in the training from 2007 onwards.“The knowledge I gained from thisprogramme is enormous. I can’t finish talkingabout it now. It has improved my skillsand knowledge, and it’s going to help meimprove the quality of health services andthe care I offer my patients”.Dr. Christian Ogbodo, Resident Doctor,Obstertics and Gyneacology Department,Parklane Specialist Hospital Enugu‘Attendance as at 2005 was like one patientin a week and in a month no delivery wasrecorded; even when recorded, it used to beone in months and no drugs to administer topatients. But now in a month we record upto six or more deliveries and more patientsnow visit the health center’Mary Egbo, health worker, Mburumbu PrimaryHealth CentreTraining TBAsGiven that TBAs are important providers of delivery care for many women in Enugu, the SMoH decidedto orient TBAs on the maternal danger signs. The idea was that this would result in earlier referral ofwomen in danger to a Comprehensive Emergency Obstetric Care (CEOC) centre.A short programme was developed to meet these needs and the orientation of TBAs commencedin September 2007. As of early 2008, approximately 165 TBAs had been oriented. One district, Udi,established a TBA network in an effort to encourage and improve dialogue with this influential groupof health providers. Over 300 TBAs had joined the network by early 2008.Provision of EquipmentIn an effort to rapidly improve EOC management, each of the State’s six district hospitals was providedwith an EOC kit in 2005. These kits were initially not used to the extent expected, but this changedsomewhat when LSS was provided. PHC facilities supported by PATHS were provided with sufficientequipment to provide basic emergency obstetric care. HMIS data indicated that there had been asubstantial increase in the number of public facility deliveries over the period 2003-2007, although thefigures need to be viewed with caution given the gross under-reporting of deliveries.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 51
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 30 and 31: Health Board and the Districts. The
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 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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