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 ...
The selection process resulted in three faith-based hospitals providing care under the scheme; oneeach for the north, central and south sections of the district. Contract details were agreed and amemorandum of understanding to inform the day-to-day operation of the scheme was signed bythe respective partners. The scope of the scheme was restricted to those requiring inpatient care upto and including a 14 day period beyond delivery. Given the limited budget available for what wasthought would be a high demand scheme, robust monitoring and control mechanisms were builtinto the pilot. The referrals were initially restricted to the PATHS supported clinics located in the ruralparts of the district, which were zoned with one of the faith-based providers. The clinics were asked toexercise discretion so that women who would not normally use private or faith-based hospitals, due tocost, were given priority for referral. However, the referring clinics were later expanded given the lownumber of referrals initially.The women referred were charged a maximum of N 10,000 (approx £40) for services, regardless of theactual cost. This constituted on average about 25% of the cost. A joint committee representing theDHB, providers and PATHS was established to monitor implementation of the pilot.The pilot started in November 2006. It ceased asa pilot in December 2007 when the governmenttook over the funding of the scheme. Whilst theuptake of the scheme was initially very muchslower than anticipated, the number of womenusing the scheme increased in 2007, and by early2008 80 women had benefited.“Mother of Christ has cared for 29 womenthrough the scheme. After 12 months Iwould suggest that 50% of the women caredfor would have died had the scheme notexisted.”Consultant Obstetrician,Mother of Christ HospitalImmunisationConsiderable thought was given to what action could be undertaken by the state in order to promotean increase in the uptake of routine immunisation (the idea was that this should complement theFMOH’s supplemental immunisation campaigns).A decision was made to commission an NGO,CREASUP, to use their highly successful peerto-peerchild support approach to encourageschool children to educate their peers, parentsand communities of the need for all childrento be routinely immunised. The campaign wascentred on schools, both primary and secondary,and in the communities surrounding theEarly Bird Clinics. These were the first PATHSsupportedclinics and were selected to maximiseimpact, given the training of the EBC staff. Overthe period October 2005 to September 2006,the NGO trained 1,350 peer educators andschool facilitators who reached some 40,000secondary school children, 43,000 primaryschool children and 50,000 people across thelinked communities.CREASUP is an NGO that works withchildren to effect behaviour change. Asmall core of children who are linkedto the NGO learn about the particularrequirements of the work from seniorCREASUP staff. They become the trainersand, using drama as a learning medium,they teach other children and adults inschools or at community level about issuesaround which changes in behaviourwill help save lives (or bring about otherpositive changes at individual, householdand community level). The children arenot only highly effective, but also in highdemand.54 PATHS Final Programme Report
“The introduction of routine immunisationhas gradually reduced the belief in “Ogbanje”which was the traditional reason given forthe high infant mortality rate amongst ourpeople for many years.”Mothers waiting to have their babiesimmunised at Bishop Shanahan HospitalIgwe Kingsley ChimeIntegrated Supportive SupervisionTo ensure that positive changes among providers and at facility level could be sustained, on-goingsupervisory support was essential. Supervision needs to be supportive rather than punitive if thegreatest change is to be effected. Recognising this, PATHS worked with the various state teams todevelop and implement separate monitoring and evaluation mechanisms for many of the individualsystems strengthening and service delivery improvement activities. However, this approach provedvery costly and time-consuming on the part of the monitoring teams, and demanding on facilitystaff. In line with the other PATHS states, Enugu moved towards an Integrated Supportive Supervisionapproach.An ISS approach and tools (covering all the constituent bodies of the DHS, including facilities) wasdeveloped on a consultative basis. This was piloted in three districts in late 2007 and later rolledout to the SHB, DHBs, LHAs and all facilities. Early results from the ISS teams indicated that 50%of the facilities were moving in the right direction. Most of the facilities that scored well had beeninvolved in the systems strengthening or service delivery improvement activities. This suggests thatfacilities require some element of support from either Government or donors if they are to improve,consolidate and sustain their services.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 55
- 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 52 and 53: Where care is givenEnugu’s health
- Page 54 and 55: Enugu State Total Deliveries in Pub
- 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 66 and 67: 64 PATHS Final Programme Report
- Page 68 and 69: Intermediate Outputs1) The DHS stru
- Page 70 and 71: 5) A culture of business planning a
- Page 72 and 73: 70 PATHS Final Programme Report
- 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
“The <strong>in</strong>troduction of rout<strong>in</strong>e immunisationhas gradually reduced <strong>the</strong> belief <strong>in</strong> “Ogbanje”which was <strong>the</strong> traditional reason given for<strong>the</strong> high <strong>in</strong>fant mortality rate amongst ourpeople for many years.”Mo<strong>the</strong>rs wait<strong>in</strong>g to have <strong>the</strong>ir babiesimmunised at Bishop Shanahan HospitalIgwe K<strong>in</strong>gsley ChimeIntegrated Supportive SupervisionTo ensure that positive changes among providers and at facility level could be susta<strong>in</strong>ed, on-go<strong>in</strong>gsupervisory support was essential. Supervision needs to be supportive ra<strong>the</strong>r than punitive if <strong>the</strong>greatest change is to be effected. Recognis<strong>in</strong>g this, <strong>PATHS</strong> worked with <strong>the</strong> various state teams todevelop and implement separate monitor<strong>in</strong>g and evaluation mechanisms for many of <strong>the</strong> <strong>in</strong>dividualsystems streng<strong>the</strong>n<strong>in</strong>g and service delivery improvement activities. However, this approach provedvery costly and time-consum<strong>in</strong>g on <strong>the</strong> part of <strong>the</strong> monitor<strong>in</strong>g teams, and demand<strong>in</strong>g on facilitystaff. In l<strong>in</strong>e with <strong>the</strong> o<strong>the</strong>r <strong>PATHS</strong> states, <strong>Enugu</strong> moved towards an Integrated Supportive Supervisionapproach.An ISS approach and tools (cover<strong>in</strong>g all <strong>the</strong> constituent bodies of <strong>the</strong> DHS, <strong>in</strong>clud<strong>in</strong>g facilities) wasdeveloped on a consultative basis. This was piloted <strong>in</strong> three districts <strong>in</strong> late 2007 and later rolledout to <strong>the</strong> SHB, DHBs, LHAs and all facilities. Early results from <strong>the</strong> ISS teams <strong>in</strong>dicated that 50%of <strong>the</strong> facilities were mov<strong>in</strong>g <strong>in</strong> <strong>the</strong> right direction. Most of <strong>the</strong> facilities that scored well had been<strong>in</strong>volved <strong>in</strong> <strong>the</strong> systems streng<strong>the</strong>n<strong>in</strong>g or service delivery improvement activities. This suggests thatfacilities require some element of support from ei<strong>the</strong>r Government or donors if <strong>the</strong>y are to improve,consolidate and susta<strong>in</strong> <strong>the</strong>ir services.“<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 55
Change language