The Giant Strides of EU-UNICEF Health Project in Bauchi Primary Healthcare System

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Bauchi State, in the northeastern region of Nigeria is one those states that have  some serious challenges regarding  Maternal , Newborn, Child Health and Nutrition  (MNCHN) in the country. 

The above assertion can be seen in both the previous and current National Demographic Health Surveys (NDHS) reports, where Bauchi State  is clearly highlighted as having high maternal, under five and newborn mortality rates. 

This persistent statistics have been a source of worry for the Bauchi State government,  development partners and all other stakeholders in the health sector. More disturbing is the fact that most of these health challenges are more pronounced in the rural areas, where access to health care services to, particularly, pregnant women, nursing mothers and under five is often difficult due to a number of factors that include, but not limited to; absence of health facility, poverty, nonavailability of drugs and other medical commodities, care givers, attitude towards orthodox medicine, absence of friendly health facility environment and equipment etc. 

There were series of interventions by both the Bauchi State Government and  partners to reverse the ugly trend bedeviling primary healthcare services especially in the rural areas, where it is more challenging. 

It is in an effort to address these gaps that the European Union (EU) in collaboration with UNICEF Nigeria also joined in the crusade by carrying out an integrated primary healthcare intervention to support the state government in addressing some of the enumerated challenges surrounding MNCHN. 

The EU-UNICEF project titled,  “Strengthening Primary Health Care and Community Resilience for Improved Maternal, New-born, Child Health & Nutrition (MNCHN) Outcomes, is being implemented in three Northern States of Nigeria of which  Bauchi State is also selected. 

The main goal of the collaborative effort according EU-UNICEF  is to  contribute to the reduction of maternal, new-born and child mortality and morbidity in Bauchi  State towards  the achievement of Sustainable Development Goal (SDG) 3, with the overall objective of improving the nutrition and health status of women and children through a sustainable primary health care delivery system and improved community resilience. 

The intervention, which commenced almost two and half years ago  is being implemented by UNICEF Nigeria with the EU funding of  54 Million Euros, has recorded remarkable achievements in strengthening primary healthcare access and service delivery across the entire state. 

Our correspondent, who recently visited some of the benefiting PHCs, has come face to face with the positive  impact the EU-UNICEF is making towards enhancing effective, efficient and quality service delivery on the supply side and high turn out of clients seeking these services on the demand side. 

The multimillion naira intervention includes renovation of all the targeted PHCs, supply of hospital equipment and drugs and strengthening the capacity of health workers. Other part of interventions are mentoring of community health workers, conditional cash transfers and mobile services extended to communities living in hard to reach settlements.  It can rightly be said that the EU -UNICEF health intervention is a complete integrated project that other health related sectors leverage on to upscale their activities.

 This was buttressed by Abdullahi Maigari Jalam,  the Water Sanitation and Hygiene (WASH) Coordinator of Dambam Local Government Area when he mentioned that, “The WASH unit of my LGA capitalizes on the high turn out of women coming for antenatal in those health facilities that were renovated by EU-UNICEF to carry out our hygiene promotion talk. Prior to the intervention,  we don’t have a choice than to follow these women and caregivers to their settlements for such awareness campaigns. It has saved us a lot of resources and manpower”. 

In her testimony too, an expectant mother of two that came for antenatal at the Jalam PHC, Rashida Mohammed, said her joy is that now she can access health services and free drugs at the PHC without paying anything. “Before the EU-UNICEF intervention most of us don’t come for antenatal or postnatal care due to financial constraints but now we are being given free drugs during antenatal and we also deliver here at the facility without paying anything”. 

To corroborate Rashida’s claim, the Ward Development Committee chairman of Jalam Ward, Mallam Ibrahim Umar also mentioned that the health intervention carried out by EU-UNICEF has greatly improved uptake of health care services like immunization, delivery at facility and improved hygiene practices. He also revealed that the free services and drugs have made their work of convincing male caregivers into allowing their spouses to seek medical services at the PHC. “If the husband is not paying anything for the medical services rendered to his wife,  he has no cause to stop her from going”, he said. 

Also speaking to our correspondent,  the officer In charge of the Jalam PHC Adamu Abdullahi said the EU-UNICEF project provided the PHC with lab equipment, delivery beds, drugs, trainings, motorcycle for outreach, waiting chairs and had also given the PHC a facelift that made  the environment conducive for both the staff and clients. 

“Not only do we have more clients, but even some communities from other neighbouring LGA like Darazo visits our PHC. Also clients from Dari  settlement in Yobe State are accessing our services. Services like lab tests and scanning are being conducted due to the project interventions”, Abdullahi enthused. 

The same testimonies greeted our correspondent when he visited Dagauda Model PHC also in Dambam LGA, another PHC that benefitted from the project intervention. 

Our correspondent, who was conducted round the facility by the officer in charge Yakubu Yahaya, saw some of the equipment supplied to the PHC under the project. These equipment include sterilizing pot, curtains, delivery beds, theatre lap, medical cabinets chest, motorcycle and some other hospital consumables. 

Our correspondent also bumped into the Nutrition Focal Officer of the LGA, Waziri Ayuba  at the Dagauda PHC. 

The focal officer informed our correspondent that he has made it his business to pay routine visit to the  renovated PHC because of high turn out of clients. This, according to him, enables him to observe if there is any child that suffering from malnutrition, so we can refer them to our CMAM sites for treatment before degenerating into Severe Acute Malnutrition. 

The officer in charge of Dagauda model PHC,  while reacting to our correspondent on the issue of birth registration, was quick and excited to respond,  saying, “with the high number of women that are now delivering in our facility because of intervention, birth registration is automatic. We also try to capture those that were not delivered in our PHC during our outreach activities  that was possible due to the  use of motorcycles provided by EU-UNICEF. Routine immunization has also improved significantly too”. 

While expressing his appreciation for the intervention, the acting director of Dambam LG Primary Healthcare Department Adamu Hamman said the EU-UNICEF project came at the time when the LG are in such dire need of such support. 

“This support has greatly improved antenatal care in both Jalam and Dagauda PHCs. For instance, in 2018 quarter 1, Jalam PHC ANC attendance was 361 and delivery at the facility was 133. 

The number improved to 472 for ANC and 195 deliveries at the facility recorded  in 2019 quarter 3. In the same vain, Dagauda facility ANC attendance was 368 in 2018 quarter but jumped to 470 in 2019 quarter 3. So,  there is quite an improvement in women accessing medical services from what it used to be before the EU-UNICEF intervention”. 

This delightful testimonies of the EU-UNICEF health project from Dambam LGA stakeholders in the sector  were also replicated in Giade LGA,  another benefiting LG of the project. 

Our correspondent was fortunate to interview three clients that were actually being attended to at the Giade Township Model PHC. 

Fatima Adamu was in labour, but even the pangs of  pains she was going through could not stop her from expressing her gratitude to the “people” that provide the new hospital equipment she saw at the PHC. 

Also, another nursing mother that had just given birth to a baby boy at the Giade Facility, Asma’u Sule from Bagaje (a Fulani Settlement) also shared her experience during the delivery with our correspondent. “ I didn’t know they have nice delivery beds, curtains and lights in the delivery room. The workers attended to me professionally despite fact that my husband is not  paying for anything. I like the new look of the hospital and also the attitude of the workers. When i go back to our  settlement,  i will tell other expectant mothers about the PHC and the new equipment they have”. 

Also, another nursing mother Hafsatu Ya’u from Giade , who happened to be on admission when our correspondent visited the health centre, said that , although it was she that was on admission, but her baby that was suckling at that moment was delivered at the facility. Hafsatu also informed our correspondent that she attended all her antenatal and post natal care at the Giade township PHC. She also mentioned that her child did not missed a routine immunization and was also issued with his birth registration certificate. 

The successes recorded at Giade PHC was articulately captured by the officer in charge of the facility Mallam Magaji Ibrahim Jugudu. 

He disclosed that, “as at April 2018,  the general attendance of the facility was 926, with ANC visits at 199, labour/delivery 30, immunization 49, family planning 38 and HIV testing and counselling standing at 547”.

Jugudu further said that, “The EU-UNICEF intervention has remarkably improved the statistics. According to him, as at August 2019, general attendance to the facility has significantly jumped to  3320, with ANC having 243, labour/ delivery also rose to 49, family planning 58, immunization 93, while HIV testing and counselling stood at 783”. 

Interventions and Achievements so Far Recorded:

In Bauchi state, several interventions under the EU-UNICEF health are being carried out to meet the overall  objective of the project , with many achievements recorded. These include:

1. Supply of standard equipment to all 323 main PHCs in the state (1 PHC/ward).

 2. Health workers trained to improve their capacities in delivering quality of care services in the PHCs, including Modified Life Saving Skills (MLSS), Quality of Care, Prevention of Mother-to-Child transmission (PMTCT), Integrated Management of Common Childhood illnesses (IMCI), Integrated PHC services, Health Management Information Systems

3. Free commodities supplied to the main PHCs to ensure free treatment for all under 5-year-old children; free Ante-natal Care (ANC), hospital deliveries and post-natal care (PNC), including screening of every pregnant woman for HIV; and providing the ones confirmed positive with Antiretroviral drugs to prevent mother-to-child transmission.

4. Engagement of volunteer health workers (Nurses/midwives, Community Health Extension Workers, CHEWs; Junior Community Health Extension Workers, JCHEWs) and record officers to visit hard-to-reach (HTR) communities that find it difficult to access standard health care services in the PHCs in 9 LGAs (Alkaleri, Bauchi, Toro, Ningi, Ganjuwa, Misau, Katagum, Zaki and Gamawa). Several integrated services including ANC, PNC, management of labour and deliveries of pregnant women, immunization, nutritional screening, screening and treatment of common childhood illnesses (Malaria, Pneumonia, and Diarrhoea diseases), and treatment of common ailments, are provided at the community level. The 9 teams in these LGAs have attended to over 90,900 under 5 children, and over 8,500 pregnant women who all benefitted from one or more of the integrated services being provided.

5. 1,200 Volunteer Community Oriented Resource Persons (CORPs) were trained on Integrated Community Case Management (ICCM) of common childhood illnesses (Malaria, Pneumonia, and Diarrhoea disease) with guidelines/protocols to follow to continually deliver treatment of these illnesses in their various HTR communities. These volunteers who cover 1,200 settlements, are from the settlements they cover and reside in these settlements. They are kitted with tools and commodities necessary for easy diagnosis and treatment of children aged 2 months to under-5 years (59 months). They were also trained to refer conditions with danger signs that are beyond what they were assigned to treat. Health workers from the main PHC in each ward where the CORPs operate were also trained and empowered to supervise the CORPs monthly. This is also a strategy to bridge the gap of easy access to PHCs by those HTR communities. All treatment is free. So far, the CORPs have seen and attended to over 93,000 under 5-year children, and treated over 68,000 for malaria, diarrhea, and pneumonia in those HTR settlements.

6. Community-based Management of Acute Malnutrition (CMAM) was one of the interventions of UNICEF in the state before the coming EU-UNICEF MNCHN project. However, the project scaled up the intervention, previously in only 3 LGAs (Kirfi, Katagum and Dambam), with additional 6 LGAs (Bauchi, Darazo, Gamawa, Itas Gadau, Tafawa Balewa, and Warji) to 9 LGAs. This has led to screening, admission, and successful treatment of 91.4% of over 24,000 severely malnourished children in the 6 EU-UNICEF funded CMAM sites. EU-UNICEF also provides micronutrient powder (MNP) to 6-23 months old children in the state, especially through the CMAM sites to prevent malnutrition; and has since commencement in second quarter of 2018, reached 84,482 children aged 6-23 months with MNP covering 168% of the project target.

7. The project also engaged the services of Clinical Mentors (Doctors and Midwives from General Hospitals, and the LGA MCH Coordinator) in all LGAs to visit all main PHCs in each LGA to continually mentor the health workers to ensure quality of care.

8. 212 Motorcycles have been supplied to selected main PHCs to help the health workers carry out outreach integrated services to distant settlements.

9. Renovation of selected PHCs (108) to improve infrastructure ongoing, with 32 already completed.

10. Conditional Cash Transfer (CCT), a Social Protection Program (SPP) in 3 LGAs (Bauchi, Katagum and Misau) where a pregnant woman is enrolled into ANC and given transport fare of N1,000 in each of her recommended 4 ANC visits; N4,000 when she delivers in the health facility and child receives first immunization vaccines;  and N1,000 in each of the next 4 immunization schedules for the child. These amount to a total of N12,000 for one woman from pregnancy stage, through delivery to fully immunized stage of the infant. This strategy is designed to bridge the gap of financial barriers hindering pregnant women in remote communities from attending ANC; delivering in the hospital or fully immunizing their children against preventable diseases. Over 3,500 women have benefitted from the scheme in the 3 supported PHCs.

11. The project has also supported the state through National Population Commission (NPopC) and State Primary Health Care Development Agency (SPHCDA) to conduct Birth Registration (BR) of children through mass campaigns and through routine BR at the PHC levels; and so far, over 1,420,000 under 5-year children have been registered and received BR certificates.

These, amongst several other interventions, are the strategies employed by UNICEF to meet the objectives of the European Union (EU) funded MNCHN project in Bauchi State. 

It could rightly be said that the intervention is steadily achieving the goals for which it was conceived and it is hoped by all stakeholders that this all encompassing health will reverse the negative health indices that Bauchi State is associated with. 

It is gladdening to note that the current administration of Governor Bala Mohammed, through the State Primary Health Care Development Agency is also keying into the model of the EU-UNICEF intervention by targeting other PHCs that are not benefiting from the intervention by carrying out renovation and equipping of such PHCs.