Health Minister Prof. Isaac Adewole’s Talking Points at the 2016 National Health Facility Survey Results Dissemination Meeting
I am delighted to be here to preside over the dissemination of the 2016 National Health Facility Survey Results conducted by the Federal Ministry of Health. It is another landmark achievement of our Saving One Million Lives, Programme for Results (SOML PfR) initiative which we promised Nigerians. I am particularly happy that the result of this survey is ready on schedule which I believe, will provide an insight into the current realities of our health facilities in the country.
Although, the overall result of the 2016 NHFS showed a general sub-optimal performance on all major health indicators and the Quality of Care indices but we observed some general improvement compared to some previous similar surveys. May I add that States with results at the bottom of the ladder should not be discouraged but we should all receive findings from this survey as a great opportunity and a catalyst for CHANGE. Beyond the SOML-PforR, the Disbursement Linked Indicators (DLIs), the performance bonuses and making the results public, the overarching objective of this entire exercise is to strengthen our health system and quantitatively improve health outcomes in Nigeria.
We now have clear evidence to inform urgent follow-up actions, and our responses can now be backed directly by robust data, rather than (as was previously the case in general) what we think or how we feel a situation should be improved.
Distinguished Ladies and Gentlemen, let me give specific action points that we could all use to move forward from key findings of the 2016 NHFS. I will like to speak briefly on four priority areas that require immediate action:
A. Clinical Competence and Knowledge of Healthcare Workers
B. Availability of Commodities
C. Availability of Minimum Equipment
D.PHC Management and Supervision
Clinical Competence and Knowledge of Health Care Workers:
Data from the 2016 NHFS showed that in-service training has a measurable positive impact on clinical competence and knowledge of health care workers, though much less than might have been expected. The following conclusions can be drawn:
1) In-service training improves health worker competence and ability. There is a pressing need to carry out more in-service training for health workers, particularly CHEWs and J-CHEWs;
2) However, the quality of the training must improve (competence of trainers, number of trainers per training session, number of trainees or participants per training session, hands-on training versus just listening, practical demonstrations vs just theory, knowledge test and/or clinical exam at end of training before certificates are issued, etc.);
3) Continuing professional development should be encouraged for all health workers (doctors already have this as a requirement for license renewal).
Finally, States and their State Primary Healthcare Development Agency/Board (SPHCDA/B) must find ways to motivate, encourage and reward excellence among their health workers.
Availability of Commodities
Though inadequate funding remains a major factor, it is not the only reason for stock-out of essential drugs and commodities. Facilities also need to be better managed. Interestingly, our data showed that the performance based financing (PBF) facilities are doing better on this issue.
May I suggest that we consider the following options:
1) Decentralizing funds to the health facilities appears to be a quick way of improving many aspects of health services. My suggestion is that State Government should adopt this strategy for an efficient service delivery.
2) SPHCDA/B should encourage and make the Ward Development Committee functional to be able to provide leadership and proper oversight.
3) State should begin to adopt Performance Base Financing in their health facilities.
Availability of Minimum Equipment
My suggestions here is as follows:
1) All State government should commence full and accelerated implementation of the Primary Health Care Revitalization Programme: Like I always stated, “there is no Federal CITIZEN, we all belong to States”. However, the FGN through FMOH is supporting revitalization of PHC in a phased version. We have started revatilising 1 model PHC per senatorial district (110); DFID is revitalizing 774 and some States have started.
2) States MUST take up the responsibility of proper PHC management, find and apply innovative solutions such as PBF, and work with all relevant stakeholders including ward development committees (WDCs), CSOs and others, to ensure long term sustainability as well as effective, efficient operations of the PHCs going forward.
PHC Management and Supervision
At the moment, the quality of supervision in our health facilities is weak and strengthening it could be done with minimal cost. Supervision is already being done but there needs to be a greater use of checklists that needs to be left in the health facilities. In keeping with international best practice, checklists must be improved and should be quantitative (and objective), allow multiple visits to be shown on the same checklist, and allow details to be left with the health workers in the health facility.
Ladies and gentlemen, I wish to advise that the following action points should be undertaken:
1) A checklist for Standardized Integrated Supportive Supervision (ISS) for each type of health facility (Health Post, Primary Health care Clinic/Center, Secondary, Tertiary) should be urgently finalized and formally adopted by the National Council on Health for use by State Government.
2) We will ensure that Monitoring and Evaluation, and ISS are carried out monthly at all facilities (the data showed that health posts were consistently overlooked in some States).
3) In the next NHFS, only documented evidence of ISS (copy of standardized ISS tool left at facility) will be accepted by the enumerators as confirmation that an ISS visit had actually been conducted.
4) We will ensure that there is periodic and routine supervision of data collection and analyses to ensure quality results that will inform decision at the highest level.
5) The supervision and subsequent analysis of the outcome data must incorporate a greater emphasis on accurate record keeping of income and expenditure.
6) Maintenance of data accuracy from the service delivery point throughout the HMIS has great implication for the quality of decisions that are taken based on the data. The high level of disparity between the data sources and the monthly summary reports at the health facilities in this survey is a pointer to a weak HMIS. We need to strengthen routine M & E. The ISS must remain focused on this, if our HMIS is to become more reliable.
7) We must leverage on the SOML PforR Innovation Fund: For example, can we develop an electronic application that uploads data in real time during the supervision exercise?
Before I end my speech, I will like to call the attention of this gathering to the challenges associated with user fees. Out-of-pocket payments to access health services remains a major barrier to timely health interventions which often cause a catastrophic outcome. State should begin to initiate healthcare financing mechanism that will support prompt access to timely intervention if we are to make a “big-bang” in our quest to achieve Universal Health Coverage in Nigeria.
Let me publicly appreciate the efforts of young men and women that are working tirelessly at our SOML PfR office for a job well delivered. I must also acknowledge the support of all State Governments for allowing our staff to conduct this survey unhindered. My special appreciation to our development partners especially the staff and management of the World Bank, Nigeria office, The Bill and Melinda Gates Foundation, The Global Fund, and UK Department For International Development (DFID) for their technical and financial support.
Let me conclude by emphasising that the 2016 NHFS has provided a great opportunity for improvement and I strongly believe that the result shall influence appropriate policy direction at both Federal and State Governments. I have already directed the National Programme Management Unit to immediately begin preparations for the 2017 NHFS. I therefore call on our development partners to support the timely conduct of the 2017 NHFS. I have also directed the National Programme Manager of SOML PfR to urgently initiate a process of publishing key results in a high-impact journal for wider dissemination.
After a period of protected analysis, the FMOH shall make available the data for academicians, researchers and other development partners to use the data for secondary data-analysis. Let me caution that all publications from this data should be accompanied by a formal acknowledgement of SOML PfR, Department of Family Health, Federal Ministry of Health.
Once again, I congratulate everyone who participated in organizing this event.
Thank you and God bless the Federal Republic of Nigeria.
Professor Isaac F. Adewole, FAS, FSPSP, FRCOG, DSc(Hons)
Honourable Minister of Health