Everything You Need To Know About the Health Ministry Response to North East Humanitarian Crisis

The Challenge

The insurgency in the six states of the Northeast of Nigeria had debilitating effects on the health of the people. A number of people in Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe were displaced and properties belonging to both public and individuals were destroyed. The insurgency resulted in displacement of approximately 2 million people, 4.5 million vulnerable people and across the six states and about 25 million impacted differently, including food insecurity. The situation resulted in destruction of health facilities, equipment and supplies. Health personnel were displaced and some lost their lives. The effect was inability to deliver quality services to the vulnerable, including those in camps and host communities. The situation in the northeast, has been described as one of the worse humanitarian challenges in the world. The need to respond to address the immediate health and other needs became urgent. The government and humanitarian agencies (over 62 of them) marshalled efforts and resources to respond to the critical needs of the people.

Our Response

1. North-East Health Sector Humanitarian Crisis Response Strategic Plan

The Federal Ministry of Health (FMOH) played a lead role in the development of a humanitarian response strategy involving key development partners in the health sector. The main focus of the strategy is to provide life saving services to the displaced persons and the communities hosting them. Integrated in the response initiative, was the focus on strengthening the health systems as a strategic move towards recovery. The North East Health Sector Humanitarian Crisis Response Strategic Plan (HSHRP) 2016–2017 was costed at (N95,306,108,43)

Borno: N52,769,765,050
Adamawa: N18,862,138,969
Yobe: N21,142,313,575
Gombe: N843,120,000
Bauchi: N4,097,200,000
Taraba: N1,492,960,000

The Objectives of the strategic plan are:

  • To ensure access of affected population to an Essential package of Primary and Secondary Health Services.
  • To improve access to Cost-effective Tertiary Care Services
  • To Restore and Strengthen the Health System functions.
  • To strengthen the capacity for Disaster Preparedness and Response at the three tiers of the health system,
  • To support State and Local Government authorities to improve the communities’ involvement in risk mitigation and overall Community Resilience.

a. State Specific Operational Plan

To operationalize the strategy, the FMOH with assistance from the Victims Support Fund (VSF) and MNCH2, supported the six affected states to develop operational plans for addressing the impact of the insurgency in the health sector. The operational planning exercise in the states lasted over a period of four (4) weeks between October and November 2016. This plan will serve as a veritable tool for assessing funds for key intervention areas and effective coordination. The total cost of the implementation of the State Specific Operational Plans is N31,217,190,506

Borno: N4,236,149,155
Yobe: N7,160,820,755
Adamawa: N4,723,772,044
Gombe: N1,381,106,553
Bauchi: N1,306,491,900
Taraba: N12,408,850,099

b. Health and Nutrition Emergency Response Plan:

Following the Health Sector Response to Humanitarian Crisis Plan, State Specific Operational Plans were programmed to be developed with States in the North East. At the preparatory stage of the assignment, a nutritional emergency was declared and a Rapid Response Team (RRT) was mandated by the Honourable Minister of Health (HMH) to amongst others facilitate the establishment, implementation and management of multi-sectorial emergency nutrition interventions and services including the urgent development of micro-plans for each of the intervention areas. This health and nutrition emergency overshadowed the development of the state specific operational plans.

The RRT returned with an emergency operational plan which was costed and valued at Twenty Billion, Five Hundred Million, Three Hundred and Sixteen Thousand, Four Hundred and Ten (N20,500,316,410.00) only. The plan in response to the health emergency was developed with the engagement of partners and State Government

While preparing for the health emergency response plan and state operational plan, World Health Organization (WHO) declared a level 3 emergency in Borno State thus necessitating the immediate need for a coordinated immediate response/intervention by FMOH and subsequently the development of state specific operational plans.

Sequel to the level 3 emergency declaration by WHO, Mr. President, inaugurated the Joint Inter-Ministerial Task Force Committee (IMTF) to tackle the Humanitarian Crisis in the North East made up of Honourable Ministers of various sub-sectors such as Agriculture, Health, Power, works and Housing, Water Resources, Defence, Interior, Education, etc. This is chaired by the Honourable Minister of Budget and National Planning.

Consequent on the formation of the Inter-Ministerial Task Force the sum of Four Billion, Three Hundred and Forty Four Million, Six Hundred and Two Thousand, Eight Hundred and Fifty Naira (N4,344,602,850.00) only was approved by Federal Government for implementation and will dovetail to the 2017 Borno State Operational Plan. The eight (8) thematic areas of this plan are costed as follows:-

Nutrition: N844,854,400
Wash and Sanitation Hygiene (WASH): collaboration with FMWR. (nil cost)
Service Delivery: N2, 841,441,800.
Staffing: N448, 760,000
Coordination & Sustainability Framework: N50,375,000
Communication & Social mobilization: N18,837,000
Logistics and Supply: N103,485,000
Monitoring and Evaluation: N36,849,650

2. Health and Nutrition Emergency Response Implementation:

a.Ad Hoc Staff Recruitment:

In line with best practices and international standards, the Ministry commenced the implementation of the Health and Nutrition Emergency Plan by placing adverts in its web site, two (2) national dailies (Daily Trust and the Nation) of 26th December, 2016 calling for interested volunteers and was followed by a pre-selection process which was carried out through collaborative efforts between staff of the Borno State SMOH, Directors of the FMOH including the Director Human Resources and resource persons.

This recruitment, selection and placement exercise took place from 9th -13th January 2017. More than 2000 applications were received veering for the positions. It was agreed that this pre-selection exercise would serve as a prototype data base for available manpower for the Health sector in the State and subsequently dovetail into a proper detailed database going forward. This was proposed to be in fifteen teams of eight health care providers details at follows:

a. 1 Doctor

b. 1 Pharmacist/Pharmacist Tech

c. 1 Nutritionist

d. 4 Nurses; (2 RN, 2 RM)

e. 1 Lab. Scientist/Lab Tech

However, under the guidance of the HMH and working with the Borno State Government, in order to make some efficiency gains, the teams were increased from fifteen to twenty-five teams to provide support for all the twenty-five accessible LGAs and the composition of each team further strengthen to address new and emerging realities within the available financial envelope provided for in the plan. Each team will now comprise as follows:

f. 1 Doctor (N350,000)

g. 1 Pharmacist/Pharmacist Tech x1 (N250,000)

h. 1 Nutritionist (N80,000)

i. 3 Nurses x3 (N180,000); (Reg. Nurse x2, Reg. Midwife x1)

j. 1 Lab. Scientist (N170,000)

k. 1 Lab Tech (N80,000)

l. 4 CHEWs (N80,000)

m. 1 HMIS Officer(N80,000)

The training of engaged Volunteers and FMOH Team took place on Monday January 16th, immediately after the recruitment and selection process and lasted for one week.

The recruitment and orientation of relevant volunteers climaxed with the formal flagged off by the Honourable Minister of Health and the Executive Governor of Borno State of the Health and Nutrition Emergency the Response Plan on Saturday, 21st of January, 2017.

The orientation involved training on IDSR (surveillance, rudiments and architecture of IDSR etc), Nutrition, Essential Drugs management (including Reporting/Requisition for medicines and health related commodities, Monitoring & Evaluation (M&E), Basic security for working in emergency situations, Team Management and Coordination, Finance, Logistics, accommodation and House-keeping issues etc.

The 25 teams were deployed into 25 accessible LGAs– (Abadam, Askira Uba, Bayo, Bama, Biu, Damboa, Dikwa, Chibok, Gubio, Gwoza, Gudzamala, Hawul, Jere, Kwaya kusar, Kaga, Kala Balge, Marte, MMC, Monguno, Mobbar, Magumeri, Nganzai, Ngala, Shani, Konduga) and will provide basic package of primary care services currently being provided by existing teams plus additional integrated HIV/PMTCT services (as part of ANC services) and nutrition (CMAM) services with RUTF.

2b. Provision of the essential medical and other supplies

Also preparatory to the formal commencement of the Health and Nutrition Emergency Response Plan, the FMoH had donated some drugs to Borno State Government and at the approval of the Health and Emergency Plan the Ministry using emergency procurement in line with the Public Procurement Act 2007 procured medicines and medical supplies as detailed and specified in the Plan worth over 2 billion Naira. This includes Medicines, RUTF (ready to use therapeutic foods), and Logistics support like vehicles, ambulances, and drug distribution trucks etc to the tune of over N2.5Bn only. These items have been delivered and are currently being used.

c. Provision of other logistics Support:

Other items procured for the successful implementation of this Intervention Programme include Items for distribution, logistics and supply chain management Four Trucks, four ambulances, four hilux vehicles and Inventory Management Equipment etc.

d. Monitoring and Evaluation

The Honourable Minister of Health has also instituted a Transparency and Accountability Mechanism which includes a monthly Joint Monitoring and Evaluation exercise. The M&E exercise was designed to be a joint/collaborative exercise comprising of teams made up of participants from the FMoH, SMoH and relevant stakeholders.