ADAMAWA STATE PRIMARY HEALTH CARE DEVELOPMENT AGENCY TECHNICAL WORKING GROUP AND PARTNERS FORUM MEETING

9th June, 2016 10:20am Reported by: David Timothy, Technical Officer Hunpiya Makanto, Admin Officer Kwabe Drambi, Planning Officer

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1.0 ATTENDANCE i. Dr. Martins Bimba -Permanent Member I, ADSPHCDA ii. Alh. Yakubu Maaji- -Permanent Member II, ADSPHCDA iii. Aliyu Suleiman- Secretary iv. Dr. A. G. Barminus -DPRS v. H. S Buba- -Director Admin vi. Dr. Paul S. Margwa -Project Coordinator vii. Partners and Representatives of Organisations 2.0 OPENING The meeting started at about 10:20am with the Christian and Muslim Prayers. This was quickly followed by self-introduction. 3.0 WELCOME ADDRESS Dr. Martins Bimba who chaired the occasion on behalf of the Executive Chairman who was unavoidably absent welcomed everyone present and stated that there is a need for absolute openness during discussions in order to identify challenges and suggest ways to move forward. He wished everyone a happy deliberation. 4.0 OVERVIEW OF THE MEETING BY Dr. A. G. BARMINUS (DPRS) The Director Planning, Research and Statistics of the Agency acknowledged everyone stating that it is a regular meeting geared towards evaluation, looking at successes made and challenges encountered. Stressing what the Chairman said, he said that the meeting is an avenue for partners to know one another and areas of interest as well as proper awareness on what each partner is doing. He emphasised that everyone should be frank and proffer solutions. He further mentioned that the meeting is one of the criteria for accessing Primary Health Care under One Roof. He finally wished everyone a happy deliberation. 5.0 PRESENTATION ON PROGRESS SO FAR FOR ALL THE PROJECTS UNDER ADSPHCDA BY DR. PAUL S. M PROJECT COORDINATOR USING POWER POINT. The project Coordinator of all the ADSPHCDA projects presented on the progress so far made by all ADSPHCDA. That is the EU/UNICEF MNCH Project and NSHIP (PBF). 5.1 Observations, Comments, Contribution and Recommendations on the Progress so Far for all ADSPHCDA Projects Director PRS.  The key element to success for this projects in the community is full participation of the community members, because some of the Facility Managers run the facility as if is their own, they neglect the Ward Development Committee (WDC) in the activities of the Facility.  He urged the Project Coordinator (PC) to retrain the WDC or give them orientation on their roles and responsibility in the Health Facilities (HFs).  He urged the partners to come in through the SMoH, ADSPHCDA and the State Planning Commission if they are intending to partner with the State with their programs not go straight to the HFs.

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Pastor Omega. Zonal Technical Officer (ZTO) Lead NPHCDA  He Stated that so many lapses were discovered during a meeting with experts from EUUNICEF on 8th of June 2016, so they planned to go back and review the document that establish the WDC to involve members or representatives of all the Villages, Communities in the establishment of WDC in a Ward. Dr. Simon OPM RBF-TA  Dr. Simon mentioned that he attended several Facility Managers meetings but have not met with any WDC Chairman during such meetings  There is need in every facility manager’s meeting to involve WDC Chairmen or representative. Haruna Maisaje (Waste Manager NHSIP)  PBF is a learning process and this WDC members are also part of the community and they have other important jobs like farming which has made the facility managers take advantage of that opportunity to control the HFs. There is the need to motivate the WDCs by giving them stipends Yusuf Sani (SIO)  If the Integrated Supportive Supervision by the State team is in good place and on regular bases these issues could have been solved. Dr. Paul SM (PC)  Integrated Supportive Supervision is a big issue in the State at large.  He further State that NSHIP-EU-UNICEF are working hand in hand to retrain the State team on how to carry out standard and qualitative ISS and after that there will be a step down training for all the LGA teams. Director PRS ADSPHCDA  He noted that program officers are yet to submit reports on the last two rounds of ISS conducted. Director Admin ADSPHCDA  There is need to involve the admin staff in activities like ISS for proper documentation and easy reporting.  He asked why PBF facilities are entitled to bonuses while DFF facilities are not. Dr. Paul S. Margwa, PC  To the issue of PBF and DFF facilities, the Project coordinator state that by the First Quarter of 2017 all DFF Health Facilities will be PBF. Rev. Omega. State Coordinator, NPHCDA  Still on ISS there is a need to strengthen the ISS because there are issues at the National, State and Local Government levels.

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 But notwithstanding partners and the National team have agreed that the proposed trainings on ISS will be based on merit and it is a certification training. He further State that not all the program officers are going to be ISS supervisors after the training.  He informed the gathering that most of the program officers only tick the checklist without bringing out the strength, weaknesses, and challenges and develop action plans and recommendation after the Integrated Supervision. Secretary, ADSPHCDA  He emphasised that for proper management there is need for proper channel of communication.  The Secretary stated that for the over one year he has been at the Agency, no report has ever passed on his table so he wondered who the program officers are reporting to. Director Community Health Services  In her defence, the Director State that the program officers are supposed to report to their respective directors but very few are reporting to her. Makama Program Officer IMCI  He stated that in his case, he always discuss with his director, plan and finally send his report at the end of the activity. Yusuf Sani (SIO)  He also concurred that the program officers are answerable to their directors and they report to them Director PRS ADSPHCDA On this note the director concluded by saying every program officer will follow the proper channel of communication. And also they should report directly to their directors. 7.0 PRESENTATION ON THE ACTIVITIES OF ICRC BY DR. AUDU L. E. The International Committee of the Red Cross ICRC is one of the partners that support ADSPHCDA and is based in Geneva. Dr Audu explained that the ICRC has been a strong partner of the State Government especially due to insurgent activities in the region. He narrated that the ICRC only works in such places were insurgency and natural disasters have affected the livelihood of people. Hence in Adamawa State, the ICRC are supporting 3 Health facilities in and around Yola including (Malkohi, Girei and Vunoklang) and also 3 in Mubi North (Betso, Muva and Lokuwa). These facilities were fully renovated by the ICRC, boreholes were sunk and an overhead tank reservoir was constructed for adequate water supply for each facility. However, there is shortage of Human Resource in all the facilities renovated. As a result, the ICRC through the SMoH recruited CHOs and Midwives, furthermore, they supplied essential dugs to these facilities. This organization together with the WDC and VDC in all these areas where the HFs were located were engaged to agree on a price for transporting pregnant women on referral to Secondary facilities.

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In Michika LGA, the ICRC supported HFs with essential drugs and all HFs in Michika, Mubi North and Yola. All supplied drugs are free. The ICRC observed that salaries were nor regularly paid to health workers which affects their output, hence they provided incentive for some services as a form of finance based reward. These achievements are from the Health Department of the ICRC. Other departments who are actively involved in the State include the Engineering department who renovated the HFs and supplied water and installed solar panels, other are involved in food distribution, fertilizer and seed distribution. Another important arm of the ICRC is the RFL which stands for Reuniting Family Links. They help in reuniting children to their families who were separated while fleeing the insurgents. Other support includes: distribution of seeds and fertilizers to the IDPs that are going back to respective home, provision solar light in HFs they support and also renovations, supports or helps those affected by armed conflict and promotes compliance with International humanitarian laws. 7.1 CHALLENGES  Some areas are still difficult to access due to heavy presence of the military  In Malkhohi Camp Clinic data collection and management is given us difficult despite the support they have been given there is no data on ground to justify their work. Because of this ICRC is withdrawing its support for Malkhohi Camp and taking the support to Michika LGA.  In response to this, the PC informed the meeting that an action was taken to address the issue from the Agency when an outcry from partners came up. Redeployments were made and the PC and DPRS pleaded the ICRC to remain in Malkohi and that the case will be followed up and before the month runs out and things will change. Dr Audu responded that such decisions are not within his reach but he will forward the plea to higher authorities during the bilateral meeting. The M&E officer of the Agency said that data on drugs is very poor in most facilities in the State and that something must be done immediately. The PC then said that all Executive Secretaries in the State will be informed to keep track of such records henceforth while the DPRS said that there is now a new tool or register for keeping records of free drugs supplied and consumed by facilities.  The TB program officer raised his concern that whenever partners supply free drugs to HF around IDP camps and host communities, that they should include drugs and medications for treating skin infections. That he screened for TB and skin diseases in all IDP camps in Yola. There wasn’t TB in all but that a quarter of them had some form of skin infection which they may likely infect others with. That the supply side of medication for such cases is low therefore he pleads with ICRC to include it in their free drugs program.  A question was asked about the utilization of the Village Development Committee (VDC) and Ward Development Committee (WDC) by the ICRC and if the two will not be conflicting with the PBFs RBF committee. Dr Audu responded that the use of VDC or WDC depends on the size of the wards. Larger wards with multiple villages will have a large WDC composition drawn from each VDC. Rev Omega further clarified that in PBF if a ward has multiple HFs, then the chairperson of the VDC that houses the HF becomes the signatory to the HF account and not the WDC chairperson. . Page 5 of 9

8.0 PRESENTATION ON THE 2016 ACTIVITIES OF WHO BY Y. A INDABA World Health Organization is one of the major partners in the State ACTIVITIES CARRIED OUT IN 2016  Special intervention programs: The organization have set up immunization points in areas where the HFs cannot cover, in IDP camps, market place and Borders  He also emphasized on the need for proper documentation.  He further congratulated the Agency for their effort to end polio in the State and keep the status quo.  He stated that Nigeria has interrupted polio transmission and has been removed from among polio endemic countries. Documentation is now key to certifying Nigeria polio free after the evaluation by experts that will soon be in the country  WHO have set up mobile health team in 10 LGAs, the team consist of three persons (CHEW, JCHEW and 1 person from LGA) their job is to reach where activities of some partners have not reached and WHO is paying for their incentive.  Training of informers.  LGAs supported by WHO includes: Michika, Mubi North, Mubi South, Girei, Yola North, Yola South, Fufore, Toungo, Ganye, and Mayo Belwa LGAs.

CHALLENGES  Lack of data and improper documentation.  Inadequate Supportive Supervision by the State team.

8.1 Observations, Comments, Contribution and Recommendations on the WHO ACTIVITIES OF 2016 The Director Planning, Research and Statistics state that UNICEF also have mobile teams in Yola, Mubi North, Mubi South, Girei LGAs which are part of the LGAs initially mentioned by WHO . In response Dr. A. Yakubu state that it is ok if the Agency, WHO and UNICEF can work together and come up with Terms of Reference. 9.0 PRESENTATION ON THE ACTIVITIES COMMITTEE (IRC) BY LIMASAYA IJAI

OF

INTERNATIONAL

RESCUE

IRC is founded in 1933, they are in 43 countries all over the world. The organisation’s mission is to help people whose lives have been shattered by conflict and disaster. IRC serve people who are displaced in their countries or States. They are multi sectarian. CHALLENGES  Referral System  Security reports for Madagali LGA 9.1Observations, Comments, Contribution and Recommendations on the IRC ACTIVITIES

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 Rashida Tahir, Program officer on Social Protection said that there are problems with referrals to Secondary Health Facilities. IRC need to assist in this area.  In response, Limasaya Ijai state that they are working on that currently. But the major problem is some people take advantage of the referral system by referring minor illnesses that can be treated at the PHCCs to secondary facilities.  To the above statement, Rev. Omega said that referral cases should be clearly specified at the HFs. 10.0 PRESENTATION ON THE ACTIVITIES OF CDC DR. FELIX M. The organisation is currently supporting Michika, Mubi North, Mubi South, Girei, Yola North, Yola South, Fufore, Toungo, Ganye, and Mayo Belwa LGAs.t 10 LGAs that are bordering with Cameroun Republic. They support routine immunization, and they have supervisors from Abuja to support Michika and Madagali LGAs with the recent polio outbreak in Borno State. CHALLENGES  Security  Ban on motorcycle. 11.0 PRESENTATION ON THE ACTIVITIES OF SOCIETY FOR FAMILY HEALTH BY. 11.1 Projects in Adamawa: • Women's Health Project (WHP) • Expanded Social Marketing Project in Nigeria (ESMPIN) • Emergency Transport Scheme (ETS) • Sales and Distribution. 11.2 Locations Covered in Adamawa:  All LGAs in Central Senatorial District  All LGAs in Southern Senatorial District  Plan to Scale up in 3rd Quarter 2016 to the Northern Senatorial District 11.2 WOMEN’S HEALTH PROJECT Women’s Health Project (WHP) focuses on expanding women’s access to family planning with emphasis on long term methods and post-abortion care (PAC) services through a network of healthcare facilities. SFH currently operates with 9 Private Health Facilities in Adamawa. Areas of Intervention:       

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Training of Health Service Providers Supportive Supervisory Visits (SSVs) Clinic Support Days (CSD) Provision of Service Support Package Supplies of health Products Interpersonal Communication on FP in Communities through IPCA. Referrals to health facilities for FP services

11.3 EXPANDED SOCIAL MARKETING PROJECT IN NIGERIA ESMPIN aims to increase the use of modern family planning methods and child health products. To achieve this, the projects tend to increase accessibility of modern family planning (FP), reproductive health (RH) and child health products, through the following areas of intervention:  Increase use of health products and practice of healthy behavior through Interpersonal Communication Agents.  Distribution of contraceptives, ORS/Zinc and water treatment products (Water guard plus and PUR).  Mobilization of men to improve male involvement in maternal and Child health issues. 

Emergency Transport scheme.  The project aims at contributing to saving the lives of pregnant women (with obstetric emergency) in Adamawa State through the use of Emergency Transport cars/ taxis provided by the National Union of Road Transport Workers (NURTW) to access health services in suitable health facilities.  The projects cover 16 LGAs in Central and Southern senatorial district in Adamawa.

CHALLENGES  Staff Shortages (Human Resource) Observation  The DPRS asked the organisation about their experience with NURTW. In response, the representative of SFH said that the relationship is cordial, but from initially they encountered some resistance from the drivers but as at time everything is ok  Mr. Haruna Mai Saje asked Suppose a woman comes to the PHCC and the PHCC refers her to secondary HFs. What role will SFH play? To this, SFH responded by saying they only support HFs with commodities.

12. 0 PRESENTATION ON THE ACTIVITIES OF INTERNATIONA ORGANIZATION OF MIGRAT (IOM) BY They came to Adamawa State to support IDPs They carry out:  Physical activities to IDPs (NYSC, Malkhohi and Daware).  Economic empowerment to IDPs.  Biometrics Registration of IDPs.  They are in Michika and Madagali and Gwaza (Borno State)LGAs.  They distribute saloon equipment for IDPs.  They sank bore holes in our host communities and IDP camps.  For referral, they referred them to our other partners IRC, ICRC etc.  They are piloting project to study whether women are given leadership position in IDP camps (case study of Malkhohi Camp)

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13. 0 PRESENTATION ON BIRTH REGISTRATION The program is aimed  To ensure that all Adamawa State children from 0-17yrs have been registered. CHALLENGES They cannot register all the children because of lack of staff and they have trained Health workers to take records at facility level but they have shortage follow of data because of too much work at facility level. They pleaded with ADSPHCDA to monitor the birth registration register during their next quarter ISS. To the above statement the DPRS, ADSPHCDA said all PBF HFs are monitoring the birth registration.

NEXT MEETING TO HELD IN 3Q16 14.0 AOB GENERAL OBSEVATIONS BY DR. SIMON MBUNYA OPB RBF-TA  The TWG and partners forum meeting is very interesting but the time is too short.  It is important that every organization, NGOs, Agencies, Ministries, Board to be present in this TWG and partners forum meeting.  They need common template for easy presentations and reporting.  Secretariat should be active and inform every one whether through mail, text or letter in time for easy preparations.  Agenda to be shared some days to the meeting so as to know whether a partner will present or not and the area of focus.  During State Steering Committee meeting the key issues from TWG and partners meeting should submitted to the member of the State steering committee meeting for deliberations and necessary actions. CLOSING REMARKS Director PRS ADSPHCDA The Director Planning, Research and Statistics thanked everyone for participation, contribution, observation and presentation towards the success of this meeting and adjourned the meeting around 3:50pm.

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