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

SUMMARYThe PATHS programme was operational in Enugu State from 2002 to 2008 and duringthat period worked with four Health Commissioners and six Permanent Secretaries. It washoused within the State Health Board premises which did much to promote a harmoniousand cohesive working relationship with government structures. Whilst PATHS workedpredominantly with the State Ministry of Health, it also worked in partnership with anumber of other government ministries; including Local Government, Economic Planningand Finance and the Local Government Services Commission. In addition, the programmeworked with a number of faith-based hospitals; a large selection of NGOs and CBOs; and itspartner DFID programmes, particularly the State and Local Government Programme andthe Health Commodities Procurement project.The introduction of a District Health System (DHS) was at the heart of Enugu State’s health reformagenda. The vision was that a DHS would allow primary and secondary health services to beintegrated, marking an end to fragmented and inefficient service delivery. The devolution ofmanagement under the DHS was also expected to create new opportunities to revitalise poorlyfunctioning primary health care facilities.PATHS support to the State Ministry of Health (SMOH) in Enugu focused on the development andstrengthening of the underpinning systems that would allow the DHS to function. Once the basicsystems were in place, efforts turned to improving service delivery. With the support of the DFIDHealth Commodities Project, much-needed drugs and equipment were supplied to the health facilitiesthat were supported by PATHS (approximately 100 at the conclusion of the programme). A MinimumService Package, standards of care, and a Drug Revolving Fund were introduced, all of which helpedto improve service delivery and increase access. Extensive staff training, both clinical and non-clinical,was provided in 28 key areas. Approximately 2,500 staff benefited from training in Life Saving Skills(LSS), financial management systems (FMS), business planning, health management informationsystems (HMIS), and inter-personnel communication skills (IPCC), among others.Given that in 2002 the majority of patients in Enugu used private or faith-based facilities, PATHSsupported the SMOH to develop public, private partnerships in health. The provision of EmergencyObstetric Care (EOC) services by three faith-based hospitals, with funding provided by the EnuguDistrict Health Board, was pioneered under the Enugu EOC+ Pilot Scheme. Early results suggested thatthe scheme had resulted in a number of mothers’ lives being saved, and was a promising example of apublic-private partnership.PATHS also supported the SMOH and the constituent bodies of the DHS to develop partnerships withNGOs and community-based organisations, with the aim of utilising their skills, competencies andlinks with communities to create demand for services. Efforts were also made to increase communityparticipation and engagement in local service delivery. To this end, community representation on“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 7