People, governments and health workers in Northern Nigeria remain extremely concerned about the high levels of illness and death amongst mothers and children, where the rates of deaths among mothers and children are some of the highest in the world.
As part of the fight to reduce this unnecessary death and suffering, the PRRINN Programme has been helping to revive routine immunization in Yobe, Jigawa, Katsina and Zamfara states. From 1st September 2008 PRRINN is expanding, so that it will cover health care for mothers and children, not only immunization . This is made possible by the addition of Norwegian assistance to the PRRINN funding of the British Government.
The purpose of the new PRRINN-MNCH programme is to improve the quality and availability of all maternal, neonatal and child health services. These services include antenatal and postnatal care, safer deliveries, care for newborn and young children, better nutrition, and routine immunization. Above all, the people of the four states need good and effective Primary Health Care (PHC) services, so the PRRINN-MNCH Programme will be helping governments and health staff to get these working well and mobilising communities to understand the benefits of these services and utilise them. At the beginning of the programme, most people were not taking advantage of the PHC facilities. For example, less than 10% of the children were fully immunized and most mothers gave birth at home without the benefit of a trained birth attendant.
Prior to PRRINN start-up in October 2006, PHC service budgets were inadequate to support staff supervision and training, drug supply and facility maintenance, or health promotion. Advocacy and technical assistance to government, political, traditional and religious leaders as well as support to communities to demand services is beginning to bear fruit. PRRINN support has been laying the foundation for well-funded and managed PHC services by providing technical assistance for quality services and by working with Federal, state and local government authorities to plan, budget and monitor funds and activities effectively.
Each state now has its second annual, costed health plan and most of the 92 local governments have developed their first detailed health plans and budgets to use as a basis to advocate for release of adequate PHC funds. Regular vaccine supply to thousands of health facilities has significantly increased and repairs to all solar installations have ensured that the hot climate does not destroy the vaccines. Transport policies have been developed. Health staff have been trained on all aspects of routine immunization and empowered to carry out a peer review of their PHC service delivery and the State Ministry of Health has begun regular supportive supervisory visits. Communities are beginning to be empowered to learn about and discuss the benefits of utilising modern health services and many mothers and children are beginning to go to health facilities for the first time in their lives. A concerted effort to harmonise donor support to government is also beginning to create effective synergies and maximise programme benefits.
By December 2012 the programme aims to help each state achieve:
Good care for maternity emergencies and fewer maternal deaths
50% more women getting antenatal care and many more deliveries by skilled birth attendants
60% of infants under 1 year fully immunized, so there is 80% less measles and new polio cases are near zero
Numerous health centres rehabilitated and working well, serving 50% more women and children
More trained health staff at health centres and hospitals
Practical and concrete Federal support for PHC
Greatly Increased Nigerian and outside funding for PHC, that is being used and controlled effectively
Strong, integrated management of PHC services — from state level down to the grass-roots
Greater accountability and responsiveness to patients and communities
Community members working together to become better informed and help each other use more health services in 30% of the wards
Effective collaboration between key state ministries, agencies and donors in health sector reforms
World-class operational research by Northern Nigerians, finding solutions for priority local problems.
Under the leadership of the National Programme Manager, Dr. Garba Idris, the existing PRRINN teams will gain additional experts in Maternal Care, Health Systems Management, Operational Research, and Governance. Additional state-level staff and 15 LGA Engagement Officers will also assist states, LGAs, health facilities and other stakeholders to carry out an increased range of activities, such as governance reforms of the health sector; building staff capacity; strengthening management systems; basic rehabilitation and re-equipping of health facilities; and establishing sustainable drug supplies. This will build on the work that PRRINN has started and the commitment to strong partnership with local stakeholders at every level.
The combined PRRINN-MNCH Programme was designed in close collaboration with stakeholders in each state and will become part of the state health plans. It will continue until December 2012, with a total of £41 million in funding from the UK Department for International Development (DFID) and the Government of Norway. Health Partners International, Save the Children UK and GRID Consulting of Nigeria will continue to manage the expanded programme. They will be assisted by the Health Reform Foundation of Nigeria (HERFON), the Programme for Appropriate Technology in Health (PATH), the Centre for Communications Programs at John Hopkins University (JHU/CCP), Liverpool Associates for Tropical Health (LATH), Ahmadu Bello University (ABU), Columbia University USA and the University of Oslo, Norway.