The Coming of 'Kano Manage PHC'

 In 2021, an assessment was carried out in the primary healthcare facilities in Kano state across five thematic areas of the World Health Organization’s framework for leadership and management which are functional governance, institutional processes, management competency, performance management, and enabling environment.

The finding from the baseline assessment showed key deficits in seven thematic areas that need a serious address for the primary health care centres to work efficiently. The thematic areas are data management; financial management, facility management, Human Resources for Health, logistics and supply chain, planning and community relations, and quality of care.  

On data management, the assessed health facilities struggle with the submission of fully populated National Health Management Information System, NHMIS forms; over 50% of the assessed health facilities were unable to conduct and manage review sessions to disseminate and use data to inform program decisions; Primary Health Care Centres, PHCs do not have a system for proper storage and archival of data tools; on Human Resources for Health, HRH, health facilities performed fairly with major gaps in the management and tracking staff leaves and performance appraisal; health workers lateness and absence from work continues to be an issue in PHCs; health workers are typically informed of their job functions “informally”, structured orientation is not well implemented or lacking entirely across HFs; on logistic and supply chain, over 60% of health facilities performed well for quantification and drug dispensing subthemes, while underperforming in stock management and DRF subthemes; surprisingly 24% of PHCs do not communicate the recommended drug dosage, usage and adverse effects to patients.

On planning and community relations, the majority of the assessed health facilities conduct planning and community relations activities but some gaps remain with the documentation of findings from the planning process and routine implementation of action points from WDC meetings. On financial management, health facilities performed abysmally in budgeting with over 80% of the assessed health facilities struggling with budget development; health facilities performed fairly at conducting expense management with suboptimal delineation of roles for some expenses processes exposing the inadequacies of financial management processes; while funds are remitted by health facilities to the appropriate banks, some financial management processes (transmission and documentation of receipts) that will improve the transparency of fund management is lacking, and lastly, quality of care, most primary health care centres have poor/no system for soliciting patient feedback and key performance indicators for tracking quality of care; also many facilities do not/poorly document Quality Management Team meetings and do not know how to develop Quality Improvement Plan; and 72% of them do not fully fill their referral forms & only 6% of their follow-up on referral cases.

Based on these findings and in an effort to address them, supporting partners from the Bill and Melinda Gates Foundation, BMGF, TA Connect, and Solina Centre for International Development and Research, SCIDaR joins hands with Kano state primary health care management board, KNSPHCMB via the state ministry of health to offer helping hand in addressing the finding.

A program ‘Kano State Primary Health Care Management Capacity Strengthening Project’ which is simply coined ‘Kano Manage PHC’ came into being to address the challenges identified. Two [Nasarawa and Dawakin Tofa] out of the six zones under the board were identified where the facility managers of the facilities under the zone will be trained for ten days on the seven identified thematic areas in two batches, the first batch held between 21^st August to 1^st September 2023.

 

The training was provided by the competent team of program officers related to the thematic area from the board, including lecturers from Kano State College of Health Science and Technology, and partners of SCIDar who are all experts in each chosen thematic area.

Participants were intensively and rigorously trained via power presentation, group, and plenary session, and all participated actively.

The program will cover 6 months where by mentors are assigned to the participating facilities for mentoring and supervision to ensure all these thematic areas are given their due concern and treatment.

It is expected that the facility managers trained in the first phase [and those in the second phase] will justify the training received and bring into practice lessons learned in administering their facilities so that they become role models to others in every aspect.

Sani Garba Mohammed, Kano State Primary Health Care Management Board, Na’ibawa Kano.

The challenges faced by Environmental health Practitioners in Nigeria

By Aniefiok Moses, FRSH, FSEH, MEN, PhD Culled from Journal Of Environmental Health, Vol 3, No 2, June 2006

For the purpose of this discussion, we shall consider the challenges under three main heading. These are • Structural and political • Attitudinal and psychological (human Factors • Attitudinal and technological Structural and political The Nigerian nation health policy (revised) and health resource allocation are skewed in favour of curative services. Although the health policy emphasized primary health care as its corner stone, budgetary provision has been deliberately made to strengthen and sustain expensive medical care at the expense of preventive health services at the ratio of 5: 1. 

Again the total budget for the health sector has continued to fall short of World Health Organization’s recommended 11% of total budge to be allocated to health in developing countries. The lack of equity in the allocation of health resources to keep the system going. Disproportionate allocation of resource to preventive health services started from the time of first national development plan, where allocation was N6.0m for curative and N1.0M for preventive health service. This trend has continued unabated to date. Equally, the proposed National Health bill being described as national hospital and health facility bill” has been drafted to strengthen the provision of medical services in the proposed bill. 

Obviously, environmental health services are resource intensive and the outcome is usually intangible at least not immediately, unlike building a health Centre or procuring an ambulance for the district cottage hospital. Politicians are usually engulfed in this web of maneuvering resources to please the sensibility of the public at the expense of their health. The politicians end up using public resources to build disease palaces and create a vicious circle where sick of malaria, for instance, go to the hospital to get ‘cured’ and returned to community, get sick again and return to the hospital again; and this process continue unstopped. Although we always recite that prevention is better and cheaper than cure, the reverse is the order in our society. 

Well! An aspect of environmental health which usually attracts the attention of the politicians is solid waste disposal. Their aim is to move the waste from sight in an attempt to maintain clean environment and also to provide patronage to political stooge by hiring any supported as a waste management contractor. At the end more confusion is created as the emergency contractors moved and dump waste everywhere without any recourse to public health implications of their actions. This is what can be termed politicking with the health of the public. Within this scenario, much more is spent on health while very little is achieved. Therefore, there is an urgent need to reverse this trend to put environmental health on the national agenda.

 Environmental health services should be well planned and implemented. There should be public-private sector collaboration in a well-coordinated system where professionalism and expertise are the watch word. Attitudinal and psychological (human factor) We have earlier started that environmental health practice and services are both human focused. This makes it one of the most difficult professions, attitudes and general way of life. It involves ‘probing’ into people’s privacy and challenging their very way of life. Most of the time the job of inspection and abatement of nuisances involve entering people’s sitting room, bedroom, kitchen and toilet. For this reason, the practitioners are always in contact with community members. Invariably, most community members usually develop resistance to this ‘probing’ and may also develop and demonstrate some sort of uncooperative attitudes. While this persist, time is usually lost and sometimes the nuisance in question may cause more damage, which may be life threatening or may lead to actual loss of lives.

 On the other hand, the practitioners’ attitude and general disposition to their job and the general public is always being called to question. Most EH practitioners have been accused of insensitivity to public feeling and general despondency to their job. Few practitioner have been accused of pursuing self-interest and materialism. Some of these accusation have been quite embarrassing to the profession. The greatest challenge is the negative image these attitude posed to the profession. Some suggestions have been on how to tackle image problems in the profession. 

It is pertinent to state that the environmental health officer’s registration council of Nigeria is positioned to deal with negative attitudes and tendencies of the practitioners and to ensure that the profession achieved the objective it was set out to achieve. In this respect, the council will do all in its power to limit negative attitude and ensure compliance to set standard and professional code of ethics so as to preserve the dignity of the profession at all time. In between the attitude of the public and that of the practitioners are psychological issues. Environmental health relates with several other occupation and professional groups. Sometimes there are inter-professional squabbles with the intension to prove professional to superintend over public health issues, the tendency are always to pull down its fabrics against all norms thereby creating inferiority complex among its members. This complex therefore impinged on the psychology of the practitioners either the capability to shift his focus from his professional roles. Indeed, this is a very negative weapon which is not only intended to weaken the profession, but also to ridicule its goal and mandate including its statutory responsibility to the public. Closely link to this is the low educational and socio-economic status of the practitioners. 

As a profession that relate closely to community members, the professionals are sometimes seen from the spectrum of those they serve. Economically, environmental health service is still regarded as public service. Most people do not believe that the services should be paid for. Indeed, to date over 99.1% of the practitioners are employed in public institutions and agencies. In fact, record from the council registry showed that none of the 3,000 EHOs so far registered is self-employed, with the low income of the practitioners, they are always looked down upon. This creates negative socio-psychological impact on the practitioners and the profession. Low educational status of the practitioners is a great hindrance to environmental health development.

 The history of environmental health indicates that from the inception of the profession in Britain. The practitioners were poorly trained, albeit to the level of skills needed at the time. As a highly skilled profession, environmental health practitioners should be well trained and always ready to respond to the need of the society. The pedigree of environmental health manpower development has affected the status of the profession. 

The development of environmental health profession has also been hampered by inadequate personnel with the prerequisite knowledge and skills to function efficiently. Again lack of resource persons to impart the necessary knowledge and skills have been a serious hindrance to the development of the profession. To date and before the present effort by the council to reposition the profession to meet the various challenges, there was no university in Nigeria that offered courses in environmental health at the degree level. Since the BSc in environmental & epidemiology program in university of life, now Obafemi Awolowo University [OAU] was scrapped in the 80s, the program could not be mounted by any other university in the country. This situation is likely to persist for a long time unless serious intervention is undertaken by relevant government agencies to liaise with institution outside Nigeria to establish linkage and exchange programs to build up a critical mass of environmental health trainers and faculty members that will be able to deliver environmental health core sources at the BSc degree level.

 Environmental and Technological The environment which the professionals operate is very hostile. Apart from inadequate basic infrastructures like good road, water supply and other amenities that supposed to facilitate environmental health services, people awareness about EH matters is still abysmally low. It is still very difficult to show the relationship between environmental health factors like fifth, heat, poor ventilation, poor food hygiene practice, etc. and the health of the community. With such low awareness, it is sometimes very difficult to prescribe any form of strategy to abate environmental nuisance that impact negatively on public health. Indeed there is total lack of environmental health culture in Nigeria. Environmental health technology like environmental health culture is lacking in Nigeria. Most of the basic equipment used for environmental health services are still being imported.

 To this end such equipment becomes very costly and unaffordable. There is obvious relevant technology gap. The heavy reliance on imported equipment and sustenance of efficient environmental health services. The problem is compounded by lack of inadequate budgetary provision for equipment, high cost imported equipment, wrong choice of equipment, diversion of equipment to other uses, high stock of obsolete equipment, poor technical support, lack of maintenance culture and lack of spare part. The situation calls for urgent intervention. Nigerians are very creative and innovative. Public-private sector partnership would result in the possibility of harnessing our huge potentialities to develop home grown technology for environmental health services. Institution like product and equipment development Agency (PRODA), Enugu should be encouraged to fabricate equipment for environmental health service. 

Indeed, there is need to look inward for community-based approach to tackling environmental health problems so as to ensure good health and sustainable development in Nigeria. Conclusion Enforcement of environmental health standards and regulations is hinged on availability of enabling environment; structural re-alignment; focused, holistic and sustained environmental health policy which is pro-preventive health; building positive environmental health culture and acquisition of appropriate technology and proper reorientation of public perception and attitude towards environmental health matters. For the profession to meet the emerging challenges there should be a deliberate policy to increase funding to support training of the practitioners and for the building of environmental health infrastructure and technology.

 Environmental Health Officers must seek for information and develop capacity to synthesize and make use of such information for their professional development. As a basic and essential service, environmental health should not only be seen as a public good, hence entirely public provided; it should also be seen as a mean to achieving a better health, indeed as window to shop for health for all (HFA), which appear very illusory challenge and leave behind every cynicism and move forward with renewed vigor to change the environmental health landscape for posterity.

Repositioning environmental and public health services at PHC level in Kano state

By Sani Garba Mohammed

Kano state did not have an agency to regulate or monitor primary health care activities until 25th March, 2012 when the then governor Dr. Rabiu Musa Kwankwaso signed the law setting up of Kano State Primary Health Care Management Board. The primary health care concern is providing quality, effective, efficient, equitable, affordable, reliable,acceptable, comprehensive, and accessible health care services at the grassroots for the promotion and protection of the general public. To achieve this, there must be multisectoral collaboration between various components of human resource for health, as no one component can deliver all the health services alone.

Considering how some health services received more attention than others, I will look at how environmental and public health services, which are central to the success of other health services, can be repositioned at primary health care levels for better and efficient interventions in Kano state.

 Environmental health as defined by the World Health Organization is “the control of all factors in man’s physical environment which exercises, or may exercise, a deleterious effect on his physical development, health or survival”. While public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals”. And historically, public health starts with sanitation, therefore, ‘environmental health’ and ‘public health’ goes together. The following includes the functions or component of environmental health services: solid waste management; medical waste management; housing and environmental planning; food sanitation; sanitary inspection of premises; pest and vector control; epidemiological control; air quality management; occupational health and safety; market and abattoir sanitation; water sanitation; management of urban drainage; protection of recreational environment; pollution control; control of reared and stray animals; disposal of dead [man and animals]; port health services; environmental health impact assessment; weed and vegetation control; hygiene education and promotion among others, hence, the outcome of environmental health services are prevention, detection and control of environmental hazards which will affect human health Therefore, for this to be achieved we need to go back to the basic of first generating environmental and public health info of every premises be it residential, commercial, industrial, educational, hospital, etc., of our physical environment which is one of the position of National Council of Health meeting in 1994, 2000, and 2003 in Jos, Ilorin, and Kano respectively. 

 In order to achieve these, federal government produced national guidelines on environmental sanitation, sanitary inspection of premises, excreta and sewage management, school sanitation, solid waste management, market & abattoir sanitation, pest and vector control, food hygiene and control, injection safety & healthcare waste, laws and regulations, environmental health guidelines for sanitation in child care centres [pre-school] and special homes in Nigeria, environmental; health guidelines on meat inspection and abattoir sanitation, among others. In order to generate these information, section 5 subsection 2 of Kano state public health law, no 3 of 2019 provided that every premises shall have a file to be opened by Environmental Health Officer by filling a form call EH1 which contains all the necessary public health information identified in the above policies and empower him/her by section 5, subsection 1, section 6 [subsection a-c], section 11 [subsection 1-4], to enter any premises and do his work and even have the power of police constable while discharging his/her duties via section 52 and protected by section 55 while discharging his/her duties. When and if every premises has a file and its information is compiled, each would be classified according to its class, and its peculiar public health inspection checklist would be apply to it for routine inspection [form EH2] from time to time to ascertain its public health worthiness, whereby a certificate of either fitness for habitation, fitness for continued habitation or fitness for continued use of premises would be issued. The information generated/identified in any premises, public health issues detected, action taken are all documented monthly [via form EH 8] and at the end of the year [via EH 14/15/, is summarized for records and other government interest. 

 Considering these activities as important as it is, but were not being felt by the government, it set up an executive committee on sanitation in 2015 to see how these services could be integrated in one place for coordination and better results. The committee recommended what is called ‘Kano State Environmental and Sanitation Board’ KESAB to be domiciled at Kano Ministry of Environment, but that could not be achieved because there is no money to create a new agency, and the enormity & specialty of the designated responsibilities of the supposed board could not allow its integration into the then Refuse Management and Sanitation Board, REMASAB, a department of environmental and public health was created instead at the state primary health care management board on 9th December, 2015 at the state executive council meeting. For the department to succeed, discharge its duties as identified above, and justify its relevance in the scheme of health services and maintain a lead, impact, dedication, and direction, it must be innovative, accommodative and responsive, for, the coinage ‘environmental’ and ‘public health’ placed a great task on it, and government is looking to see more of its activities, via regular report & activities, and others, precisely now that the new nomenclature in the world is ‘environmental public health’, which places more burden on it. 

 The state public health was amended in 2019 to be in tune with the current needs, all policies, regulation, laws [around 50] in my count, should be made available to every practitioner [technician, technologist and officer] to study, and be familiar with it, so that they can apply it at the specifications of their jobs description. Equipment like Dissolved Oxygen (DO) meter, calorimeter, measuring tapes, thermometers, P.H meter, turbid meter, noise peak meter, carbon- monoxide (CO) analyzer, infrared analyzer, and others should be provided for environmental health workers to do their work scientifically. 

 Also, the department should liaise with relevant ministries and units where there are environmental health officers for synergy and collaboration to avoid conflict while discharging their duties. With this put in place, it should develop a short, medium and long term planning based on the ‘national strategic plan for environmental health 2015-2025’ for measuring performance against the plan.

 These activities as important as it is, cannot be done without training of the practitioners involved in the modern approach of practice which is now digital and technological, as such, their services need to be scientifically sound, socially acceptable, educationally to the standard, and go with the current trend as it is obtainable elsewhere. If environmental public health could be given serious attention by relevant authorities, certainly, the burden of diseases and other preventable tragedies can be prevented and put under control. 

This is a task that must be done to make Kano free of not only preventable diseases, but also lead in health, safety and environmental issues. Now that the Executive Secretary of Kano state primary health care management board, Dr. Tijjani Hussaini is reforming and modernizing every aspect of primary health care services, I am very sure he will give this suggestion a serious thought for the improvement and betterment of primary healthcare services.

STAKEHOLDERS APPEARANCE ON WEDNESDAY 10TH JUNE, 2020 FOR PUBLIC HEARING ON INFECTIOUS DISEASES BILL

STAKEHOLDERS APPEARANCE ON WEDNESDAY 10TH JUNE, 2020 FOR PUBLIC HEARING ON INFECTIOUS DISEASES BILL
SNo.	Name of  Stakeholder Organization
1	Equity International Initiative
2.	Action Group on Free Civil Space
3.	Catholic Women Organization of Nigeria
4.	Nigeria Immigration Service
5.	NCDC
6.	National Association of Community Health Practitioners of Nigeria (NACHPN)
7.	Association of Medical Laboratory Scientists of Nigeria
8.	Initiative for the Development of Future Accountable Leaders
9.	Nigeria Agric Quarantine Service (NAQS)
10.	Optometrists and Dispensing Opticians Registration Board
11.	AFD Coalition Against Mandatory Vaccination
12.	Society for Environmental and Public Health of Nig. (SEPHON)
13.	National Council for Women Societies (NCWS)
14.	Socio-Economic Rights & Accountability Project (SERAP)
15.	NAFDAC
16.	National Association of Catholic Lawyers
17.	Nigeria Infectious Diseases Society
18.	Nigerian Veterinary Medical Association
19.	Association of Public Health Physicians of Nig. (APHPN)
20.	Society for Public Health Professionals of Nig. (SPHPN)
21.	Doctors Health Initiative
22.	Happy Home Foundation
23.	Association of Catholic Medical Practitioners of Nigeria
24.	Foundation of African Cultural Heritage
25.	Epidemiological Society of Nigeria (EPISON)
26.	Nursing & Midwifery Council of Nigeria
27.	Veterinary Council of Nigeria
28.	Alliance on Surviving Covid-19 and Beyond (ASCAB)
29.	Christian Lawyers Fellowship of Nigeria (CLAFON)
30.	Environmental Health Regulation
31.	Coalition of Civil Society for Citizen Action Against Covid-19
32.	Health Sector Reform Coalition
33.	University of Lagos (Faculty of Law)
34.	National Islamic Centre Zaria
35.	Nigerian Medical Association (NMA)
36	Legislative Advocacy Initiative for Sustainable Dev. (LISDEL)
37	Nigeria Governors Forum (NGF)
38.	National Islamic Centre, Zaria
39.	Association of Public Health Physicians of Nigeria (APHPN)
40.	Chief Justice of Nigeria
41.	ALGON
42.	National Primary Health Development
43.	Nigerian Association of Resident Doctors
44.	Medical Laboratory Council of Nigeria
45.	Nigerian Police Force
46.	Dangote Foundation
47.	UNICEF
48.	Association of Chemists
49.	Shippers Council of Nigeria
50.	National Institute of Legislative Studies NILDS
51	Magistrate Association of Nigeria
52.	Dr. Mohammed Etudaiye, Faculty of Law University of Abuja
53.	Dr. Charles Omole
54.	Prof. Dimie Ogoina, President Nigerian Infectious Disease Society

 

 

 

 

 

 

 

 

 

STAKEHOLDERS APPEARANCE ON THURSDAY 11TH JUNE, 2020 FOR PUBLIC HEARING ON INFECTIOUS DISEASES BILL
1.	Citizens Coalition Against Impunity and Injustice
2.	Pharmaceutical Society of Nigeria (PSN)
3.	Amnesty International Nigeria
4.	Traditional Medicine Association of Nigeria (TMAN)
5.	Obi of Onitsha
6.	Ooni of Ife
7.	Sultan of Sokoto
8.	NAFDAC
9.	Christian Association of Nigeria (CAN)
10.	Jamatu Nasir Islam
11.	College of Nigerian Pathologists
12.	Association of Public Health Physicians of Nig. (APHPN)
13.	Nigerian Christian Graduate Fellowship (NCGF)
14.	Professional Association of Public Health Nurses of Nig. (PAPHNON)
15.	Catholic Bishops Conference of
16.	Nigeria Health Reform Foundation of Nigeria and Centre for Health Science Training
17.	Nigerian Union of Allied Health Professionals (NUAHP)
18.	The Church of Nigeria (Anglican Communion)
19.	JOHESU
20.	Medical Health Workers Union of Nigeria
21.	Livingseed Team Inc.
22	The Stage for Women Coalition
23.	Association of Medical Officers of Health in Nigeria (AMOHN)
24.	Association of Hospital and Administrative Pharmacists of Nigeria
25.	Centre for Peace Building and Socio-Economic Resources Development
26.	Ministry of Health
27.	Ministry of Justice
28.	Ministry of Women Affairs
29.	Muslim Students Society of Nigeria, Northern State
30.	Yiaga Africa
31.	Healthcare Federation of Nigeria (HFN)
32.	Legislative advocacy initiative for sustainable develoment
33.	Catholic Secretariat of Nigeria (CSN)
34.	Joint Health Sector Unions (JOHESU)
35.	Catholic Bishops Conference of Nigeria
36.	Citizen Coalition Against Impunity and Justice
37.	NHIS
38.	Nigerian Human Rights Commission
39.	Medical and Dental Council of Nigeria
40.	Pharmacy Council of Nigeria
41.	Nigerian Bar Association (NBA)
42.	Nigerian Union of Journalists (NUJ)
43.	Nigerian Agricultural Quarantine Services (NAQS)
44.	National Association of Microbiologists
45.	Association of Airline Operators
46.	Port Health Workers
47.	Vessel Owners Association
48.	Representative of Coalition of Civil Societies