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

“Before now I had nightmares as thedelivery period approached. For me it alwayshappened in the quiet hours of the night.Nurses were rarely at the centre and werenever there during those late nights. OnlyGod, grandmother, and mother came tomy rescue. We looked like an abandonedgeneration. Now that PATHS has trained ournurses and re-equipped our health centrewe come here daily for care. At the worstwe receive an initial attention before beingreferred to the big hospital.”Enugu now has six functioning CEOC centresand 56 functioning BEOC centres in the publicsector, while enhanced care is being provided ina number of faith-based hospitals.Mary Ani, a patient at a primaryhealth care facilityPublic Private Partnership -Contracting Emergency Obstetric Care ServicesPerhaps the most innovative of all the EOC work was the provison of public emergency obstetric careservices through three faith-based hospitals at public sector prices. This public-private partnershipaimed to make EOC services more accessible to those who would otherwise be forced to incur verysubstantial costs in the private sector. The rationale for the pilot scheme was the absence of a DistrictHospital in Enugu Metropolitan District. This led to an exploration of ways to use private sectorfacilities to provide the equivalent secondary care services. The Enugu Metropolitan DHB decided toconcentrate on the provision of emergency obstetric care for poorer women living in the rural partsof the metropolitan district. PATHS agreed to support the pilot by providing technical assistance andfunding the provision of services during the life of the pilot.The initial concept was that woman using the scheme would be charged the same official user feeas those attending district hospitals in other parts of the State. If, however, the cost was greater, thedifference would be made up by the DHB.The key steps for developing and managing the pilot were:• Securing the support and political backing of the Hon. Commissioner of Health;• Information gathering by the DHB through visits and meetings with key opinion formers in bothpublic and private facilities and with key SMOH and State Health Board officials;• Selection of providers for the pilot scheme following an open, transparent and objective processthat assessed potential providers against an agreed set of criteria;• Selection of referring clinics;• Setting up the mechanisms to deliver the service;• Training staff of the primary care referring centres;• Mobilising communities in order to promote the scheme;• Tracking utilisation of the scheme.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 53