’If people don’t own it, you cannot sustain it’

PATHS 2 has been working in health for some time now, what areas do you work in?Year project aimed at supporting health system strengthening, service delivery and governance in five states in Nigeria. These states are Enugu, Lagos, Kaduna, Kano and Jigawa states in addition to working at the federal level with the Federal Ministry […]

PATHS 2 has been working in health for some time now, what areas do you work in?
Year project aimed at supporting health system strengthening, service delivery and governance in five states in Nigeria. These states are Enugu, Lagos, Kaduna, Kano and Jigawa states in addition to working at the federal level with the Federal Ministry of Health, the National Primary Health Care Development Agency, NAFDAC and other departments in the ministry. That is the primary focus but we have five major output areas.
The first area is governance, to ensure that the stewardship role is enhanced and at the federal level to assist them to be able to provide those services and policies.
At the state level we are supposed to enhance state system strengthening so that they provide services.
The third and the central output is to ensure service availability to the poor in our society.
Output four is citizen’s empowerment, which is voice and accountability, to give power to the people. These groups are civil society organisation who demand for health and also participate and demand for accountability. This is simply to hold government accountable for their stewardship, remember I said output one is stewardship.
So we are strengthening stewardship, state systems, services delivered to the poor and empowering civil society organisations to hold government accountable and output five is to provide information which is like behaviour change communication.
People are no longer accepting services because of the poor state of health that has been bedeviling Nigeria for years. So now that those systems have been put in place, services are been provided, nurses are being trained, you want to let people know that these things are there by providing them with the information so that they can make responsible decisions.
How far have you gone in implementing their outputs in these states?
I think we have done very well, because our last review indicates that we have done quite well. The state governments are very happy. When we started this project five years ago, what we did was to develop a documentary; we went round the states to show the status of health at the time.  We developed that into a documentary and gave it to the minister and he used it at the National Council of Health and people saw it because most of the time, we sit in offices and plan for the states and local government without necessarily knowing what is actually there. So what we did was to go and bring it out to them so that they can make adequate plan.
The then president, late Yar’adua, saw the documentary and was moved and organized a presidential summit on health, and brought all the governors to Abuja to ensure that they all make health a priority and at that point, they all signed and made a declaration to make health a priority.
They all agreed to make sure that 15% of their budgetary allocation goes to health. Which is in line with the Abuja declaration by the AU.
But have you tackled the issues raised in the documentary?
What we also did to change the face of the issues we presented in that documentary was to go ahead and start making changes in terms of human behaviour, capacity building at both state and local government levels.
At the federal level we started renovating and providing equipments to clinic, we started retraining nurses and doctors, training community health extension workers, empowering communities to make sure that they see these health services as their own because we believe that ownership must precede sustainability.
If the people don’t own it you cannot sustain it. So ours was to emphasise the sustainability and ownership aspect,that is how we got people involved. So we had what we call ASK Nigeria, ASK Enugu, give power to the people to ask questions, so we brought government and the people together, let the community people, civil societies ask questions from the government. These could be why we are where we are, or why is the clinic the way it is, and you hear comments like we don’t have water and when we go there the nurses are nasty, they are not even there, they abuse us and the rest.
We started using that to make changes. Now we have community and clinic staff relationship in terms of facility health committee, members of the communities working with member of the facility to governor those facilities. They are owning it  and seeing it as their own, so we can demonstrate right now that it is working, and that things are changing.

Can you give us an example of how things are changing for the better?
One particular example I would like to give is Jigawa state, which was one of the most backward states in all of them but today, they are in the front they have achieved that 15% budgetary allocation. They have improved their human resource capacity, which was quite poor before but they have increased the number of employment and even established a school of nursing, a college of nursing and midwifery, state of the art. This cannot be found in many states at this time, they have put systems in place and is functioning.
If you go to Kano State alot is being done, statistics are coming down, the governor is releasing funds and identifying and ready to participate with us.
If you go to Enugu state, you see the same things, we went to a local government area where we had community mobilization, the local government chairman brought drugs for them.
In Kaduna State, the same thing, the late governor who died about a year ago took this project as his own and we had direct access to him.
So in terms of the first output we can demonstrate that in those states capacity has been built to ensure stewardship. States are more active now, if you go there you will find drugs, nurses are being trained, systems in place are functioning right now.

What else have you done in your effort at supporting health system delivery?
One other thing we did in the last one and half year is to establish a model local government in each of state. The reason to do this is to demonstrate how to use minimum package care which has never been achieved.
So our approach is to shot for optimum package care and achieve minimum care because when you shot for the minimum and with our attitude you don’t achieve it but when you shot for the optimum you will even with our bad attitude we will achieve the minimum.
I think we have done that in most of these states, we have a costed plan, because if you are to run a LGA programme to provide optimum services, we have a costed plan to enable the state government plan.
For example if a state government has 14 LGA and he intends to spend N1m on each he needs N14m, this is to ensure that their budget are realistic. Right now they just do habitual political budgeting, they want people to hear they budgeted N1b but at the end of the year, not even one quarter of that money has been released.