Reducing maternal and child morbidity and mortality

Ordinarily, I should not comment, but my imagination run back to 80’s when PHC was given all the necessary support in the country in comparison with what he started. I was one of those that attended its lunching at National Theater Igammu by the then head of State (General Ibrahim Babangida) in 1987, and I […]

Ordinarily, I should not comment, but my imagination run back to 80’s when PHC was given all the necessary support in the country in comparison with what he started. I was one of those that attended its lunching at National Theater Igammu by the then head of State (General Ibrahim Babangida) in 1987, and I share the views of other Nigerians in asking why Dr Muhammad Ali Pate abandons one of the highest positions in the country and who will succeed him to continue, sustain and built on, if possible do beyond what he started.
I know Dr Pate initiated and championed a lot of vital programmes mainly to improve the Nigeria’s Health system notably among them are the restructuring of PHC system in the country; One example is his effort in facilitating the implementation of one of the fundamental principles of PHC i.e. constructions and upgrading of PHC centers to provide integrated health care services across the country, where over 1000 PHC model centers were constructed in rural areas, introduction of the Midwives service scheme with about 4,000 trained on life serving skills and integrated management of childhood illness were posted to the rural areas, save one million lives initiative and of course the Polio Eradication Initiative (PEI) whom was the Chairman of the Presidential Task force.
While I must confess here without any apology that we have not seen such efforts in revitalizing Health care in Nigeria since the era of the formidable Professor Olukoye Ramsome Kuti in the 80’s and 90’s, until when Dr Pate took the mantle of NPHCDA as the Executive Director and as a Minister of State for Health respectively. His focus was on improving PHC in Nigeria with particular reference to reducing both Maternal and Child morbidity and mortality, the very important question is what next and by who else?
Since, he has quit, I wouldn’t have to talk much about him, but as I said earlier, there could be many other reason(s) as to why he left the Jonathan’s administration. Some are of the opinion (could be rumors) that the working relationship between him and the senior Minister of Health Professor Christian Onyebuchi Chukwu was never cordial. I am sure by now Mr. President is looking for someone that will replace him and  with  some degree of experience of mine in both PHC in general and Public Health in particular, I wish to proffer that whoever will succeed Dr Pate as Minister of State for Health; shall built on what Dr Pate did or even beyond that and for him to be successful; must have the following:-  H/She must have the same support or even better from Mr. President as accorded to Dr Pate, H/She must have the experience, initiative,  determination, zeal and commitment  as Dr Pate or even much more better than that; and H/She must be READY to work with the senior Minister of Health such that H/She must express the spirit of team work – Together Everyone Achieve More (TEAM), without which I am sorry could be the same story or even worse. Finally, H/She must be able to work very closely and carry along the NPHCDA whom are the coordinating and supervisory agency for PHC implementation in the country.
Looking at what next and who succeed him, we must focus our attention to what the next Minister will do to sustain and built on what Dr Pate started and two important principles of PHC should be given priority and these are the community participation and provision of qualitative integrated health care services.
Having constructed and upgraded many PHC centers in the country and by employing many midwives and other health workers, what we need now is to ensure provision of qualitative health care services which should be the priority of the next Minister of State for Health in collaboration with NPHCDA. Supportive supervision or support a vision is a new concept of supervision which is to provide support to whoever you are supervising with a define plan and focus, learn from each other, share ideas as well as conduct on the job training in order to improve the quality of care; as such switch from the former supervision strategy which is usually unplanned and lack focus, and characterized by bossing, embarrassment, harassment, scoldment, fault finding and some sort of intimidation.
The technical concept of the supportive supervision is for the team to develop a schedule to visit health facilities regularly and while going they must not only carry and apply supervisory checklist, but must carry all working materials/equipment needed by the health facility in case found not available or not  working. Therefore a supervisor while on supportive supervision will provide support, (for example, if the supervisor found that the health facility does not have a register, and he already comes with register and he provides the register immediately that is supportive supervision. Whereas if you go for supervision and found no register, while you did not come with one,  you will still come back to the LGA or your base and possibly you may forget or may take time and so the health facility will be working without capturing any data, your supervision is meaningless). Finally the supervisor reviews his checklist along with the PHC center health workers and agrees on their strengths and weaknesses which should be the basis for “on the job training” immediately and the focus must be on specific areas where the health workers have lapses, mistakes and or weaknesses. H/She must however acknowledge the areas that the Health Workers are doing well to encourage them to do better.
There is need for harnessing all the effort in both constructions/upgrading of PHC centers and the initiative of midwives service scheme with a development of guidelines for supportive supervision which will ensure provision of quality of care that should focus on the services offered, the service providers (Midwives and CHEWs) and the health facility itself.  Checklists (for the three areas) in conformity with standard of practice (SoPs) should be developed and agreed along with all stakeholders at National level with States, LGAs, donors/partners and NGOs in attendance. All potential supervisors should be trained at National level to serve as National supervisors which should be cascaded to states, LGA and Ward level while the checklist should be adopted at all levels. The state supervisors should after receiving training from the National supervisors and adaptations of the checklist, plan to train the LGA supervisors who shall also adopt the state checklist and in turn the LGA supervisors to train the Ward level supervisors.
The content of the training should focus on modalities of the supportive supervision, tools and post supervision mechanism while the guideline for the supervision should be ward level supervisors to supervise all PHC centers within their domain on weekly basis, LGA supervisors to go out for supportive supervision on monthly basis, state supervisors visits LGAs on quarterly basis and National supervisors to visits States bi-annually.
The output of the supportive supervision from each level should serve as an agenda for review meeting at the various levels such that ward level should have review meetings fortnightly with in-charges of the PHC centers and supervisors within the ward, LGA to conduct review meetings on monthly basis with ward supervisors and coordinators, state quarterly review meetings should be attended by LGA PHC Coordinators and supervisors, while the National should hold bi-annual review meetings with state PHCDA, Ministry of Health officials and supervisors.
I do hope the next Minister of State for Health will patiently follow what Dr Pate did and built from where he stopped and at the same time look critically at these practical suggestions and gives a trial, to institute community ownership as well as to improve the quality of health care services in general and in particular to accelerate the reduction of both Maternal and Child morbidity and mortality in the country; and of course achieve the Millennium Development Goals 4 & 5 by 2015 and beyond as set by World Health Organization.
Babale is a member, Bauchi State House of Assembly.