Tracking Maternal Neonatal and Child Health (MNCH) Week

Budget Transparency and Accountability Initiative Network's picture
Tier of Government: 
State
Budget Sub-Sector: 
Health
Description/Story: 

CRS MATERNAL NEONATAL CHILD HEALTH (MNCH) WEEK MONITORING REPORT.

                                                                                                                         November, 2012.

 

1.0 INTRODUCTION

Any nation desirous of insuring its future must place priority on the care and protection of its citizens especially women and children. This is usually the responsibility of government to the citizens. This responsibility is carried out through programmes that seek to cater for the health needs of the women and children.

The millennium development goals (MDGs) 5 and 4 which talk about women and children mortality rate reduction underscores the importance placed on these vulnerable members of society. Since Nigeria is a member of the UN and signatory to the MDGs it behoves on the country to strive to meet the target. Doing this requires that “all hands must be on deck” in order to achieve the goals come 2015. One major way in which the MDGs (4 and 5) can be achieved is via immunization of these vulnerable groups against killer diseases.

This report therefore summarizes the result of a five day monitoring exercise facilitated by BTAN and supported by UNICEF through CRS-DIDC . The exercise which was meant to be an in-process monitoring of the just concluded maternal newborn and child health week/immunization exercise at ward and local council level has as its objectives the following:

  1. Ensuring equity through full utilization of materials supplied
  2. Determine the extent to which coverage was achieved
  3. Carry achieved coverage against target population and
  4. Determine the functionality of the LGs PHC cold chain, solar facilities etc.

Nevertheless, the exercise which was not without hitches considering the scope, limitations and constraints was implemented in the 18 LGAs of the state.

The maternal neo-natal child health week (MNCHW) a platform for immunizing pregnant women and children against killer diseases like hepatitis, measles, yellow fever, etc held in Cross River State between November 28 and December 3, 2012*. It is worthy of note at this juncture to state that the exercise was earlier slated for between November 23 to 28, 2012 but due to certain unforeseen circumstances, it was postponed to the above stated date*. The campaign was made possible through the Cross River Government with support from UNICEF.

Budget Transparency and Accountability Initiative – Nigeria (BTAN), a network of NGOs and CSOs was engaged to carry out an independent assessment/monitoring of the exercise in all the LGAs of the State. Special attention was given to areas that are termed hard-to-reach in the State because of the low/poor coverage of such areas in the last exercise that took place in June, 2012.

 

1.1 METHODOLOGY

The MNCHW monitoring/tracking was carried out in atleast 3 wards in all the 18 LGAs of the State with particular focus on the hard-to-reach wards. Please note that the list of the hard-to-reach areas was supplied by the State. Households, specifically those with immunizable children (0 – 59 months of age) and women of child bearing age were randomly selected for sampling. PHC facilities were also visited and data concerning coverage and interventions collected by BTAN’s team of monitors. A total of about 50 wards were visited in all the 18 LGAs of the State.

Approaches employed during the exercise include: focal group discussions, interviews, and observations. Summarily, it was discovered that some of communities considered as hard to reach communities or wards are no longer hard to reach because they now have access roads under the current state government’s drive to provide access to communities. An example of this is Afrike I in Bekwarra LGA. 

We learnt from the UNICEF Health consultant in the State that the hard to reach areas were generated during the planning meeting with the State health workers/officials and same was forwarded to us. However, in the field, some of the listed areas were disputed by the health workers in the field and other areas considered hard to reach by the field health workers were not included.

We (BTAN); have raised the issue of the Hard to reach areas with the Chief statistician, SBS and have suggested to the State Bureau of Statistics to come up with the hard to reach areas and indicators for arriving at what defines an area as HARD TO REACH.

Prior to the field visit, training was held for some (14) of the monitors by the UNICEF consultant (Ephraim) and Mrs. Agbor, a State Technical Facilitator in Calabar South LGA at the WHO office in Calabar. The training which held on November 21, 2012 had the monitors learning about what they where to do in the field. A step down training was done in BTAN office for the monitors that will be engaged in the field and their supervisors; it took place on November 30, 2012 with 32 persons in attendance. After the step down training, 18 of the monitors were mobilized to the field for the week’s activities. The other assistants (14) served as reviewers of the reports and made entries as the monitoring progressed.

This report will therefore highlight the following areas monitored especially with respect to hard-to-reach locations; coordination meetings, trainings, social mobilization, flag-off, commodities/supplies, services, monitoring/supervision, review meetings, funds commitment and key (other) observations.

2.0 FINDINGS

2.1 Coordination Meetings: The various stakeholders of the MNCHW including State Ministry of Health, RUWATSSA, NpopC, immunization officers held meetings in Calabar prior to the exercise in November, 2012. These meetings which held about 3 times had in attendance the Director of Primary Health and programme officers.  There were also coordination meetings held at LGAs in the various PHCs.

 

2.2 Trainings: There was training at the state level for the state technical facilitators, state immunization officer, state mobilization officer and local immunization officers on the November 21, 2012. Further trainings at the LGA level were scheduled to hold before the commencement of the MNCHW activities and reports from the LGAs show that trainings held at the PHCs and ward levels between November 15 and 27, 2012.

Meetings with social mobilization and ward development committees also held at the local government level. Awareness campaigns/rallies targeted at women groups, TBAs and youth groups as well as publicity via churches, schools, town criers/announcers and community/village councils were done. There was however a case in Akpabuyo where a town announcer refused to do the announcement because he was not paid for it.

2.3 Flag off:  This was done at the state level by the Acting Governor, Barrister Effiok Cobham at Ikom LGA headquarters on November 28, 2012. The chairmen of LGAs or their representatives flagged off the exercise in the respective LGAs with an exception of Akpabuyo where there was no flag off. In Boki, the flag off was done on December 3, 2012. That of Akamkpa was done by the chairman on November 30, 2012 in Aningeje. In Bekwarra LGA, the flag off was done by the chairman on November 27, 2012. There was no flag off in Odukpani, Biase and Akpabuyo  LGAs amongst others.

2.4 Commodities and supplies: Vaccines/drugs were distributed across the 18 LGAs of the state for the purpose of the MNCHW. These included both injectable and oral vaccines/drugs such as;

  • Vitamin A
  • Albendazole
  • Oral Polio Vaccine (OPV)
  • Tetanus Toxiod (TT)
  • Yellow Fever
  • Ferrous Phosphate and Folic Acid
  • Measles
  • BCG
  • Hepatitis B Vaccine (HBV)

These vaccines/drugs were made available with the combined effort of the state government, National Primary Health Care Development Agency (NPHCDA) and UNICEF with emphasis on hard-to-reach communities.

  • Most LGAs visited however reported a shortage or non-availability of some of these vaccines/drugs.    
  • Akpabuyo and Ogoja LGAs reported a shortage of vitamin A.
  • Bekwarra had insufficient albendazole.
  • Odukpani had a total of 28 towels, 28scissors, 11 envelopes supplied to the LGA. Other supplies included 4,900 and 28,500 tablets of albendazole for 12 – 23 and 24 – 59months respectively. Folic acid – 255,000, ferrous – 76,000, vitamin A (red) – 31,500, vitamin A (blue) – 11,500. The vaccines provided and their quantities are; BCG-780, OPV-1,000, DPT-2,100, HBV-2,100.

At the review meetings, these issues were raised with the LIO and the State UNICEF health consultant.

2.5 Services: There were services/interventions proposed for the MNCHW, these included routine immunization (oral and injectables), birth registration by NpopC, WASH, screening of malnourished children between 0 – 59months, deworming, iron foliate for pregnant women, health education, PMTCT, family planning awareness, etc.

 There was however no WASH and birth registration in Ojor (Akamkpa) but only immunization was carried out.

This was observed and reported to the LIO and LGA team during the review meetings and they committed to seeing it done.

It was discovered that birth certificates were sold to people at the rate of two hundred naira (N200) in Ntrigom health post, Yala LGA. Further enquires revealed that the directive came from one Mr. Sunday who works with NPopc in the LGA.

The field monitor took up the issue with the LIO and the action was stopped as the “Mr. Sunday” could not be located. Furthermore, the birth certificates were given free of charge. The issue was also raised by BTAN during the State review meeting at DIDC. The stakeholders agreed to join forces to stop future reoccurences.

Birth registration cards were sighted only in urban ward 1 and Alege/Ubang wards in Obudu LGA. Other wards/areas had inadequate or no cards at all. Birth Certificates were also inadequate. 

This was reported at the LGA review meeting and the team committed to covering the lapses during the mop-up exercise.

2.6 Monitoring and Supervision: The state ministry of health, the UNICEF consultant, NPHCDA and leaders of thought at the LGA level carried out monitoring during the MNCHW. Monitoring was mostly done with public transportation as they were no official government vehicles sighted anywhere during the week’s activities.

2.7 Review Meetings: Review meetings held at the end of each day’s activity usually between 4 and 6pm. Various health posts reported back to their model/apex PHCs/ focal persons at the ward level. The focal persons met at the LGA level to report their progress or otherwise and remedial action taken where necessary. Data collected was then collated and recorded at the LGA level by the focal person and the STF. It was observed in Odukpani that review meetings did not hold at a central point due to the difficult/riverine nature of the LGA, hence review meetings were decentralized depending on location.

2.8 Funds Commitment: The state government in partnership with UNICEF funded the MNCHW campaign. Some LGAs committed some funds to ensure that the MNCHW was a success. These included funds commitments from LGAs such as Ogoja, Yakurr. Specifically, Calabar South LGC supported the MNCHW with N500, 000 while LGAs like Odukpani made no commitment in terms of funds for the exercise.   

2.9 Key Observations:  The following issues were observed during the exercise;

  • Inadequate manpower – Most of the health workers complained that the number (4) per team was grossly inadequate. Most of the workers were just working to fulfill all righteousness as they complained that they have not been paid for the last exercise which held in June.
  • In Ikang Ward , Bakassi LGA- Lack of man power was a serious issues as 4 persons assigned was inadequate to cover all the designated locations. However, another issue was raised by one of the health workers that a town crier who refused to make announcement due to non-payment of allowance for information dissemination threatened that if she carried out the announcement herself, he will equally go round to inform the community members that the health workers will be coming with poison as such they should not participate.

 

  • Poor funding – this was the complaint of workers as they claim they were paid between N300 – N500 for transportation for the entire week while focal persons were given between N1000 – N1500.
  • Most of the hard-to-reach areas were not reached even when we were made to understand that special funds were allocated to make it possible to reach such areas.  For instance, in Agwagune, Biase there was no birth registration during the monitoring exercise.
  • In Ibiaragidi, Bekwarra – there was no personnel to carry out birth registration so that intervention was not implemented.
  • Poor knowledge of health staff on issues of the immunization process – it was noticed that health workers do not educate parents/guardians on any AEFI (adverse effect following immunization) or the type of drug/vaccines they were administering to the children or pregnant mothers.
  • In Akpabuyo, parents were asked to cut open vitamin A capsules with their teeth and give to their children because there was shortage of scissors and hand gloves. The inadequacy of scissors and gloves was also noticed in other LGAs like Abi
  • There were reported cases of insufficient birth registration cards/ certificates especially in Obudu and Obanliku.
  • The LGA PHC cold chains especially in Bekwarra are in poor conditions hence vaccines will be affected.

We do not have the capacity to assess the potency of the drugs/vaccines as they vary from cold-freeze sensitive but we think that the condition of the cold chain and the distance of transportation of vaccines could possibly lead to impotency. This is also echoed by the health workers in the PHC and most PHCs have to rely on the only functional cold chain in the LGA which could be over several miles relative to the location of the PHC.

  • There was a reported case of AEFI in Ogoja LGA. The specimen taken by the DNSO for follow up.
  • The state seemed not to be prepared for the November, 2012 MNCHW as it was evidenced in their postponement and hasty activities during the exercise.

3.0 Other Issues: Aside the issues marked for the monitoring, other issues emerged from the process that had effects on the MNCH process and will need to be addressed ahead of the next MNCH activity. Further details are contained in the templates for each LGA.

3.1 Payment of Stipends: The November, 2012 MNCHW witnessed serious health worker apathy. According to the health workers, this was largely due to the nonpayment of June, 2012 stipends as at the time of this exercise. They lamented that most of them had to spend money from their pockets only for them not to be paid for work they had carried out.

3.2 Functionality of PHC Facilities:  This issue was mentioned in our previous report in the June, 2012 exercise. So far from our observation, most facilities are down or in a state of disrepair. Typical examples are the ones in Akamkpa, Yala. In Obanliku the solar power is not functioning and petrol generator is used as the alternative that is not so sustainable.Also that of Nwang in Ogoja was bad as at the time of this exercise.The solar panel at Ikot Omin was said to have been struck by thunder storm and hence was out of use as at the time of the exercise. Nonfunctional solar panels were also sighted in Calabar South. 

DIDC under the MDGs project has started an inventory process on all the solar/cold chain facilities in the various PHCs/HCs/Health Posts in all the LGAs of the State with a view to resolving this.  

Recommendations

  • Adequate preparations should be made by the state government before carrying out the exercise. Assessments of health facilities should be a part of the preparatory activities before MNCHW.
  • The MNCHW should be institutionalized by legislation in the State House of Assembly (CRSHA). This will help create a better structure for the exercise bearing in mind that the State is termed a state fit for a child.
  • There should be a comprehensive training and re-training of health workers and beneficiaries on the current trends in health and immunization. This should come before, during and after the immunization exercise.
  • The traditional institution should be effectively involved especially during awareness and sensitization. This is because some reports revealed that most people in the rural areas and even urban areas are not ready to accept immunization because of certain myths and beliefs they have about immunization. A certain man in Akpabuyo said “It’s God that protects not all these immunization stuff”.
  • Provision should be made for boats and life jackets for workers going to riverine areas and vehicles/motor bikes for workers in difficult to reach areas. Security personnel should also be attached to the health workers especially in volatile areas.

 

We wish to further recommend that support for future monitoring exercises should be expanded to include Pre-implementation monitoring in the first instance and actual MNCHW implementation monitoring. This will allow for effective comparison of progress considering the inputs and output and vice versa.

 

 

 

 

                                                                                                                           


 

State (If Applicable): 
Cross River
Budget Period: 
2017
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