University of Nigeria Virtual Library

Serial No.

Author 1

NWAKOBY, B.A.N

Author 2

MRS. N. ODUKWE

Author 3

MRS.V. NJAKA

Title

Proposal for Primary Health Care Implementation.

Keywords

Description

Proposal for Primary Health Care Implementation

Category

Medical Sciences

Publisher

Publication Date

Signature

PROPOSAL F O R

PRIMARY HEALTH C IRE

IMPLEMENT AT1 ON

NJ IKOKA LOCAL GOVERNMENT AREA

ANAMBRA STATE

DR. R. A. N. N1..!i,KG3'L'

DEPARTMENT OF COMMUNITY MGDICI NE

UNIVERSITY OF NIGERIA/TT.:CHIFG HOSPITAL

ENUGU

WITH

MRS. N. ODUKWE ;4ND

MRS. V- NJAKA

Section 1 Current Health b i t i i . c . t l o ~ ~ 5

Section 2 Desired Ehtire 1Iealtl.i Cr.::.,.; A..ituation I1

Section 3 Identification of C'~!;~-~;;.xl.... . , and Constraints and btra-',-c:g; w ? c j l ' W

First Intervention : Ir:zr;uni.::, . Gion ~rogramme(EP1) I 5

Second Intervention: Cr:j.l xchgdration Ps.f> ~rmix ( ORT)

F o m t h Intervention: L u - t r i + i w Programme 15

Fifth Intervention: Sc.hool 2c:?.lth Services 20

Sixth Intervention : Zq;; ly of XssentiBl D r ? ; ~ s

Seventh Intervention : 1 icl t ir : l ~ p p l y and T C

e7;v!.?.c?l_u 11 tal sani ta t ion ~i

b

Section 4: Programme Formulntio;

1 Immunization

3 MCW ~ e r v i c e s

4 Nutrition 31

5 bchool Iiealth Serv-rice:; , 33 6 Supply of Essential Drug:

7 l J a t e r Supply and. ?;n.vironxcnt a1 Lani La- tion 37

8 Treatment o f T3ldel;lj.c ,?i ;e L-.a es

Sectionr: Budgets I & I1

Budget '1

Interventions I - L' Gpecial Target h e : : : ; :

bection 7: Organisation la, u

Summary

T h i s document r e l a t ee t o Njikoka L % d .?overnment Area of

Anambra State. Two earlier documents "5i'tua.t i nn : ~ n , z l y s i s " and

"Base l i n e Data" provide the d e s c r i p t i o n 7 r t h e c u r r e n t health

s i t u a t i o n w i t h i n the l o c a a government s.re2 :?n v e l l as basic d a t a cln

h e a l t h and health related characteristics ba:;lc,d on a r e c e n t S U * ~ Y '

v i t h i n t h e LGA i n March - Mdy 1986,

The presen t document h i q h l i g h t s t h n s ~ j l i e f l t h e a l t h situation

v i t h regards t o popula t ion and o t h e r dom ,?r7,-phic c h a r a c t e r i ~ t i c s .

The o r g a n i s a t i o n a l s l . t u a t i o n of .the s e r v i c e s i n c l u d i n g avs i l ab le

r e s o u r c e s and t h e i r a c c e s s i b i l i t y t o t h e pepuL~. t ion . The LGA has

a high pmpulation d e n s i t y w i th f n c i l i t i e ~ f a i r l y evenly d i s t r i b u t e d .

The demmgraphic p a t t e r n t y p i c a l of developing c o u n t r i e s o b t a i n a ,

namely about 67% of pepula t ion comprisfne of children under 15 yeare am!

women i n the child bear ing age group i n d i c l t i n ~ ; v need f o r emphabie on

t h e develapment of MCH services.

Cammon causes of morb id i ty and mor t : lity In the vulnerable

; ~ g e group8 a r e mainly i n f e c t i o n s i n t he urid-er .5 y m r a and r n w b i d i t y

and mortality a s s o c i a t e d with pregnmcy i n women sf c h i l d b e a r i n g age

group.

Inadequacy of watep and poor e n v i r o n m e n t ~ l m n i t a t i o n is

a t t h e r o o t of most childhomd and a d u l t in! 'cctinns, Malaria is

endemic and c o n s t i t u t e s a major source cf !xnrb i .d i ty i n a l l age groups

2nd m o r t a l i t y in t h e under- f ives .

Changes d e e l r e d i n t h e community ire-ude r e d u c t i o n i n morb id i ty

and mortality t o t h e immunizable childhood d i s e n s e s , r e d u c t i o n i n

mortality due t o d i a r r h o e a 1 diseases, t h e p revent ion of i n c r e a s e i n

malnutrition and the r educ t i on i n p a r i t y of t h e women l e ~ d i n g t o a

reduction i n maternal morbidity and m a r b d i t y n .

Pqml . s t i on increase a t i t s p r e s e n t r n t e of about 3.3% w i l l

cause increase i n demand of service,de6pitc likely r educ t ion in

' b u d g e t a r y a l l o c a t i o n , Community participnt:.or, -',a t h e r e f o r e

amticipated and advocated.

Seven i n t e r v e n t i o n s have been chosen t o achieve t h e s e

d e s i r e d nb j e c t i v e s namely:

i. Immunisation Programme

$ 1 0 r a i Rehf d r a t i on PrbgPamme

iii. Maternal and c h i l d hea l th s e r v i c c s i nc lud ing - Family Planning

iv, N u t r i t i o n Programme

v, School Heal th Se rv i ces

v i , Supply of e s s e n t i a l drugs

~ i i . Treatment of Endemic D ~ S ~ R S C S 2nd common a i lmen t s

/

I The o b s t a c l e s and c o n s t r a i n t s against t h e implementation (?f

t h e programmes have been i d e n t i f i e d i n e-ich case and inc lude t h e I

fol lowing:

I

1 i, S c a r c i t y of funds

i I Lack of equipment and drugs

! iii. Inadequate e x i s t i n g i n f r a - s t r u c t u r e

iv. Poor. l o g i s t i c suppor t

v, Inadequate community mobilizntTon and p a r t i c i p 2 t i a n i vi. Poor o r i e n t a t i o n o f s e r v i n ~ o tn f f

v i i . Poor middle l e v e l manaqeriyl cxp?r ts .

These c o n s t r a i n t s t o a g r e a t e r or less c x t e n t pervade a l l

s even i n t e r v e n t i o n programmes. I

Y The s o l u t i o n s r e l a t e t o t he n s t u r e n C t 5 c o b s t a c l e s and constr? , ints , .

A v a i l a b i l i t y of money is c r u c i a l f o r p u r c h ~ s e cf drugs and equipment,

1 f o r upgrading i n f r a - s t r u c t u r e , f o r p rov i s ion of l o g i s t i c suppor t , .for

I s t a f f t r a i n i n g and o r i e n t a t i o n and f q r commurii.ty morbi l iza t ion . -. It is

1 hoped t h n t an adequate ly m.l$lised community may then t a k e on p a r t o P

i 1 t h e m a t e r i a l and f i n a n c i a l burdens of t h e proqrsrnme i n t h e l a t e r

part of t h e p l a n period. t

~ c t i v f t i e a a r e based mainly on a s t z t i ; s t r a t e g y u t i l i s i n q

e x i s t i n g f a c i l i t i e s . Ne new f a c i l i t i e s ?re envisaged i n t h e p lan

per iod . A more v i r i l e h e a l t h educa t icn procrmmc is t o be provided fo;.,..

Two d r a f t budgets have been prepamd - < ~ e based on a n a l y s i s

o f s p e c i f i c a c t i v i t f es and r e s ~ u r c e ' rerruil'enh2ks f o r such a c t i v i t i e s

based an an a r b i t r a r y but r e l f s t i c objective ::chievement l e v e l s du r ing

t h e period. m e second d r a f t budget which is s l - s e ly r e l a t e d t o t h e

first a l l o c a t e s funds a c c r r d i n g t o ?3 s e t c n t c r o r i c s of i d e n t i f i e d

new' .-areas. Budget I c l e a r l y exceeds Bur?qe t 11 i n o v e r a l l expendi ture-

The excess r e f l e c t s f u n d s t h a t will need to bc r?ised from sou rces

o t h e r than t h e proposed FMOH a l l o ~ ~ ~ t i o n of :fSrj0,OOO. such sou rces

w i l l include t h e LGA, the Cornmunfty, Othcr y:cncies and donors.

Nc i n c r e a s e i n stsffin$ is ullow?d Tor i n the budget. P e r a o n d

ernolumenta have not been budgeted f o r and w i l l remain the respohsibilitg

of t h e LGA.. Recurrent expendi ture in l . ~ t o r v s r s of t h e p l an per iod w i l l .

be taken care of by a jud ic ious ~ p p l i c ~ t i o n oP R r evo lv ing fund g e n e r ~ : t e d

from c s p f t a l investment i n drugs i n the f i r s t ~ n d second yea r s o f t he

plan.

Budget I has a dual currency pr.icing c o r n p r i s i n ~ of Naira and US

d o l l a r s r e f l e c t i n g the hope t h s t i tems l . i i . , tcd i n t h e d o l l a r catr .gory

w i l l be aupplied a t whatever cu r r en t oxchnngc r . t e app l i ed a t t h e time

o f f mplementation by UNICEF o r o t h e r a g e n o i e ~ .

Simple i n d i c a t o r s have been prnvided fqr monitoring :.md

e v a l u a t i u n and funds provided f o r i n tto bud~ct f o r f u t u r e Picld survey:>

and s e r v i c e s research. . )

The o r q n n i s a t i o n a l s i m i u r e fcr inolementat ion has been suggested

h i g h l i g h t i n g t h e important r o l e of LGA c-mmitrn~nt. An NOH should h s n k

t h e LGA'team and work i n c l o a e co l l abo rn t ion v i t h the Unive r s i t y PHC

Co-ordinator.

No P r o j e c t development p l an re la tin^ to ' L ime is f e a s i b l e a t t h e

moment until more informat ion is a v a i l a b l e on funding, sou rces o f

material8 and drugs and t i m e f o r the ot:xr.': o i t h ? propsame. . .

STATISTICS

Popu la t ion of Njikoka L-G.A.

11 11 Children 6' - 5 years = 13.7%

C h i l d r e n under

0 - 15 years 145,682 200,573 205,589 210,729 215,997

I Women 15-50 years 102,500 a 135,062 107,690 110,382 113,141

Sectian 1

Current Health Sftuatirn

A. Health Status s i t u a t i o n :

The fo l lowing a r e t h e common m u s e s o f merb id i ty and

m a r t a l i t y i n t h e vu lne rab le age groups - c \ i l d r e n under 5 and women

of c h i l d bear ing age.

(i) Five common causes of mcrbidity i n c h i l d r e n under 5

Measles

Whooping cough

Malaria.

DI=r)Ol.J d i s e s s e s

R e 8 p ' ~ t w y i n f e c t i o n s

(52) Five common causes of mcrts l5 . f~ i n children under 5:

F e b r i l e convuls ions

Respi ra tory i n f e c t i o n s

'Wid-- diseases

Malaria

(iii) F i v e common causes of matcrnnl rnnr ta l i ty

Post partum haemorrnge

Obstructed l a b o u r

Severe anaemia of ?regn?ncy,

The main h e a l t h s t a t u s problems are those m s o c i a t e d with:

Inadequate supply of wholes om^ water

Poor environmental sanitation

Child-hood ' I n f e c t i o n s with the inmunizable

dfeeases e s p e c i a l l y mesnles 3rd whooping coUe;h

Malaria Endemicity

High p a r i t y and associated rnalnrial mot4 id i ty

and w e r t a l i t y

Ma lnu t r i t i on

Demographic S i t u a t i o n

Njikmka l o c a l Government Area has

443,725. There a r e 20 eet t lemente. Evcn.Ly destrlbutea wlcnln rne arca.

The compoaition of the vulnerable nge ErouRs is as follows:

Children under 5 years 1 3 ~ 3 % 59

/ Children of adhool age (5-15 yrs) 30.8%

Y 1 Women i n t h e o h i l d bes r ing age

i (45 - 50 years) 23.1% 102,500

A l l c h i l d r e n up t o 15 yrs. and I women i n the c h i l d b e a r i n g age group 67 - 274 278,183

School enrolment :

I c h i l d r e n of schooi age. I

( Physice l I n f r a e t r u c t u r e

Roads - There is a good network af road but over h a l f t h e roads are - seasonal , ,411 settlements are access ib l r? durj.n;; the dry eeascn.

E l e c t r i c i t y - Exists i n only 4 i?f the 20 settlcmonta.

Water - is m a i ~ l y from deep w e l l s 2nd s p r i n ~ (43%) which may be I '

P ? w o r unpiped i n t o households, Water t a n k e r s provLde about 10% of I

I , water euppliea and on ly s l i g h t l y over 7% use s u r f ~ c e water (ponds,

' r i v e r , stream, open canal-8).

I , Health Facilities s Twelve of the s e t t l e m e n t s n r e served by government I

owned facilities (1 District General Hospi tn l , 5 h e a l t h centres, I ' 1 MICmHI C l i n i c I 3 m a t e r n i t i e e and one d i ~ p e n m r y = t o t a l 15). I

homes - a t ~ t a l of 29 institution lmcated i n 14 s e t t l emen t s . I

, Private institutions qut-number t h e ,~z~ernrnent*mwaed facilitierr

compriaigg af 13 hospitals 4 mate rn i ty b a e p i t n l s , m d 12 mateknitY

Twm f a c i l i t L e ~ are under constri

settlements and only two settlements, are not nerved by any f n c i l i t i e s

I located wi th in them.

Recent survey shows t h a t on ly 15.6% of the people d r t i l i e e d

, government swned f a c f - l i t i e s .

Staffing

I . A 1 1 nursing staff, pharmacy t echn ic i ans some community h e d t h

1 flommunity h e a l t h a s s i s t a n t s are u n d e r thr S t a t e Health Managenont

1 Only borne of t h e aides, the labourerc and Nightwatchmen are

the Local Government,

h c t o r s $ Ratio to pqpulation 1:63,000) 1

Nurses midwives 36 1 1 1 1:12~000) 1

Public Health Nurses 4 11 I :11~,~00 ) 1

Comauniky Heal th Assistant 3

Public Health Superintendents 3

I R u r a l Real th I I 3

Others (~haraacy techniaians, Laboratory T?ch. e t c )

Heal th Cnre A c t i v i t i e s

~ t - p a t i e n t consu l t an t and treatmen't d - l i l y ' d o s p i t a l l s a t i o n for

~ u r g i c a l t r e a tmen t ,

Maternal and Chi ld Czre

- Antena ta l care - weekly

- Delivery i n a19 h e a l t h cen t re s and a q t e r n i t i e s

- post na t a 1 care weekly

- C h i l d welfare c l i n i c weekly

t a t i o n - weekly a t LGA headqua r t e r s ind mon':hly i n p e r i p h e r n l u n i ? .

1 Educat ion is o f f e r e d a t c l i n i c s .

3 1 of Endemic d$.eeasee - l e p r o s y t r e - t n e n t i n s p e c l a 1

and t r a c i n g of t ube rcu l a see c o n t a c t s .

7 plannfng is not o f fe red .

p t prov ided t o p e r i p h e r a l u n i t s

p i s i o n mf, p e r i p h e r a l u n i t s i s by weekly v i s i t s by ~ t a f f from

headquar ters ,

Monthly v i s i t s are also conducted' for imrnuniz?tion purposes.

R e f e r r a l is t o t h e General H o s p i t s l at Xnuqu-Ukwu ur t o

any o t h e r nearby h o s p i t a l of t h e p a t i e n t s choicf: l o g i s t i c support

is lacking msinly swing t o l ~ c k of t r a n s p o r t , EToni tor ing 2nd

evaluation is not r e g u l a r ,

Co-operation w i th e t h e r seato-s

T h i s is minimal a l t h o u ~ h t h e r e -Ire occas iona l joint meet in,?^.

Current l o c a l Government arc.1

~1178,030 or, 2.4% of t h e over-tl tbc

LGA. No p rov i s ion is made for c z p i t d projects . S t a t e

MOO-HI budget is 24.86rn ar 6.7% of o v e r a l l s t a t e budget.

A c c e s s i b i l i t y and E q u i t y

s s i b i l i t y t o f a c i l i t i e s is g o d l and t h ~ d i n t r i b u t i ~ i~ equJ +-.I ' ,.

b u d ~ e t an h c - ~ l t h care is

-1 r e c u r r e n t expend i tu r e of

Soc io Economic S i t u i

(1) No cur ren t programmes are l i k e l y t o a f f r c t health ~ t q t u s

I

much i n the m a r future. I

(2) Developments i n the apea are n o t s n t i c i p ~ t c d i n t h e l i g h t 1

of the economy i n t h e follow in^ ? rcqs , housing, e d u c a t i o n , I

water and e l e c t r i c i t y supp ly , t r a n s p o r t :~nd communication.

3 ) Agrf c u l t u r a l product i o n l e v e l shows o n l y marginal i n c r e a s e

i n s t a p l e foods.

Summary of Current Health Care Problems i n t h e LGA.

Childhoed imrnunizable d i s e a e e s e s p e c i a l l y measles and whooping

cough,

I Diarrhmeal diseases of childhood. I

Resp i r a to ry i n f e c t i o n s i n childhnod

M a l n u t r i t i o n i n ch i ldhood

Lack of fami ly planning l e a d i n q t o m u l t i p ~ r i t y and m ~ t e r n a l

morb id i ty and mortality.

Inadequa te wholesome wate r s u p p l y a n d poor s ~ n i t ? t i o n . p l a y a

major part i n the cnusa t i on of diarrhoc4 discnses .

The d e s i r e d Pr imary Hea l th Care s i t u 2 t i . n i n t h e Lmcal

Government Area by the yea r 1990 a r e as f'ol.1 O ~ . ~ E :

(1) Channes e x ~ e c t e d i n h e a l t h nreblcms

Problem Expected Change

~ h i l d h b o d Reduct ion i n morb id i ty and irnmunizable m o r t a l i t y d i s e a s e s

Technicnl 1 n t e r j e n t ion ,

EPI , Health Edukation

Diar rhoea1 Reduction i n m o r t a l i t y 0 R T Hea l th d i s e a s e s of bJt about h a l f but rninin:xl. Educator Improternent ch i ldhood r e d u c t i o h i n morbidi ty . i n water supply and

Environmental snn i t .%t ion ,

Ma lnu t r i t i on Prevent i n c r e a s e Heal th Educa t i an "? .

High parity Prevent i n c r e a s e F ~ m i l y p lanning Hea l th Education.

Expected change i n popula t ion

A r a t e of.- i n c r e a s e of a t l e a s t 2.5% is rlssumed l e a d i n g t n

f u r t h e r demands i n s e r v i c e s . T o t d p e p u l ~ t i a n w i l l i n c r e a s e from

443,725 i n 1986 t o 489,790 i n 1990 i.e. by ove r 46,000.

P o p u l s t i o n p r o j e c t i o n f o r t h e v u l n e r , ~ b l e ,Tge groups a r e as

f o l l o w s :

Age Group 1986 - 1990 - I y c r e ~ s o

Under 5 y e a r s 59 9 015 65,142 6,127

Women of c h i l d

b e a r i n g age

(15 - 50 years)lQ,500 113,382 10,882

(b) Expected changes i n the Economy - Thc economy is l i k e l y t o

d e t e r i o r a t e f u r t h e r +bk f i r e h e r r educ t ion i n o i l p r i ce s .

T h i s makes less rnoi.ey a v a i l a b l e f o r h e s l t h c a r e s e rv i ce s .

Communities ~ $ 3 1 need t o t ake more a c t i v e p l c t i n the funding af se rv i ce s . .

( c ) Environment and cornm~~nication a r e l i k e l y t o remain l a r q e l y unal+ered.

3. (a) Expected ohnnge i n ~ e k l t h A c t i v i t i e s .

Chi ld we l f a r e c l i n i c - i n c r e s s e d frequency

Immunization - i nc re??ed frequency and/er

EPE p r e gramme.

~ n t e n a t a l / p o s t n a t a l c a r e - i n c r e a s e f requency

Family p l a n r i n g ' - i n t r o d u c t i o n of p-ogrammes.

Hea l th Educat ion - dovelnpmcnl. o f . u n i t .

Con t ro l of Endemic disease6 - mp-P c l i n i c s u n i t s .

4. Changee Sn the o r g n n i s 2 t i o n and rnan~-v?ment of t h e LGA system.

The current system of d u a l c o n t r o l by JGf and sta te Health

Management Bon$d w i l l a l t a r - 1 M ~ r 1 4 r - 3 1 f l f f S c ~ r nf Ueqlth

'(F r.

A l 1

5 . Changes i n budget and amiecacion or resourcen.

(a) S l i g h t increase i n budgetory s l l r c - ? . t i o n t o l o c a l

aovernment area ma$ be phse ib le .

(b) funds by revolvinj - f i n a n c i n g of serqices

:y financial c o n t r i b u t i o n t o h e a l t h

6. Main improvement Expected in :

No new fnc i l i t i cx i w i l l be c o n ~ t k u c t e d ~

r acz lz Lies unaer cpns t ruc t ion m1-y :-)a completed.

R e h a b i l i t a t i o n of e x i a t i n , ~ roqd 9-,y be possible.

y p a r t i o i p a t i o n - moro v i l l . ? g e h e s l t h committee

' W A L L ue formed. Community rn ly incr ,z .me their f inancid

(4 I ~ P ' o the r Primary ~ . ~ , : l t h c n ~ e activities. I

~ Other a c c i v ~ ~ i e s will remain x t t h e l r present level,

Section 3

I d e n t i f i c a t i o n of Obstacles nnfl Constr~ints

6n

received immunisation,

BmC.G 'I05 Chi ld ren (16.1%) received 5 - C O G .

D.P.T. 40 11 (16.5%) rcccivcc! one dpse o n l y - 88 11 (36.4%) r e c c i v e d two doses - 38 19 (15.7%) r e ce ived three d b s e s -

~ d ' i i o 40 Chi ld ren (76.5%) received one dose only - - 100 11 (41.3%) r e ce ived t v o doses - 34 1, (14.0%) r e ce ived three doses -

' Meeslea 100 Children (41.3%) received measle, vaccine

(b) Ob jectlves: I

I (1) To achieve 80% -cwerage in the ftrst two years.

I (11) To ~cbieve 100% covernge in the ,second two m n r s

1 srnong the vulnerable age group 01

( c ) Sub-Objectives:

(I) 70% of the p4pulation will h?ve Y c c e n s to immunisntion

all the year rpund.

(11) Vaccine8 s h d d be made a v a i l a b l e t o all centres

(fn) Health ~ducat)on - TI increase the level of awareness.

( d ) Obstacles and' Constraints:

(I) Non-availability of vaccines - constraint is money I Non-availability of equipment s in existinz units

(111) Non-availability of transport and o t h e r EPI equipment

( I V ) Non-availsbility of electricity in the area other than

Abagana and the surrounding towns for the.establiahment

of a cold chain system,,

(el Strategy D ~ E

(1) Federal Government g r a n t f o r purcn m e o f vaccmes ,

v e h i c l e s and o t h e r EPI equipmrbnts

(11) Development of Abagana as tho main di~tribution centre

(111) Devslopment of one o t h e r centre 2s :I sub-distribution u n i t "

(IV) Purshase of gene ra t ing p l a n t f o r ;+hxpna and a cold bax

maht enance. I

(v) Contr ibu t ion the

P I -

SECOND IPERVENPION: ORAL REHYD? I T I O N PROQRAMME (0- R- T )

(a) In t rod t

PC

diarrhc

r a t e i~

(I) Reduct ion i n m o r t a l i t y r n t e ic 0-1 y e a r age group

from 117/1,000 t* 50 by 1987.

(11) Reduct ion i n m o r t a l i t y r x t e due to d ia r rhoea1 d i s ea se ,

( c ) Sub-Objectives

(I) Establishment of O.R.T. in dl the twelve health

f a c L l i t i e a in NjikokasLocal Government nren by 1987.

(11) Increase i n the number of mothers with knowledge of

0. R. S. prepa ra t i on from present l e v e l of almost 0%

(d ) O b t a c l e s and C o n s t r a i n t s

I (I) Non-ava i lab i l i ty of equipments - c o n s t r a i n t is money

(11) Poor u t i l i e a t i o n

(111) Lack of accommodqt ion

I (e ) Strategy Design

(I) Purchase of equipment from Fed~ral aovernment grant

(11) Cont r ibu t ion from t h e Mc?l Government t o ensure I 1 constant supply of o.R.:; o r ~u;arJ~alt.

(111) Financial c o n s t r i b u t i o n by t h c community

(TV) Health Education - (a) an p r e p a r a t i o n of 0. R-S. or sugar/ss1t s o l u t i m .

(b ) environ.aenta1 Bani ta t ion.

(V'? Mobilisation of t h e community t o u t i l i s e services

provided.

(VI) Orientation of exist ing staff cn O.R.T.

THIRD INTERVENTION: MATERNAL AND CRILT HEALTH (MCB)/ FAMILY PLAMNTNG

- ,

. . .

( R ) I n t r o d ~ c t l p n

The p i p u l a t i o n of women of c h i l d b e s r i n ~ : .?,ye (15-50 gears)

of 102,500 (23.1%) i s an i d i c a t i o n of t h e popul2t ion c f women who

w i l l r e q u i r e nn tenx ta l care.

Also from o b s s v a t i o n a l r e p o r t s from h l ? d t h workers of

i n c r e a s i n g morbidi ty and r e f e r r a l t o h o ~ p i t d ~ for va r ious problem6

of pregnant women, msternal and c h i l d health s e r v i c e s need t e be i m p r o m d .

(b) Object ives:

(I) To achieve adequate cover-qc

(11) Reduction i n maternal m o r b i d i t y 2nd m o r t a l i t y

(111) Reduction i n i n f s n t rnort a l . i t l? rrom n e o n a t i t et,nus

(c ) Sub-objectives

( I ) Inc rease number of d e l i v e r i e s a t h e a l t h f a c i l i t i e s

(11) Immunisation Programme f o r pregnant women

(111) Health Education - ITo minirnise n l o r t s l i t y and morbidi ty

i n pregnancy as wel l as i n f a n t m o r t a l i t y from neonatal tet:?nus.

( d l Obstacles and c o n s t r a i n t s

(1) Non-ava i lab i l i ty of vaccines and e?uipments

(11) Cultural and r e l i g i o u s f n c t o r s which encourage home

d e l i v e r i e s .

(e) Strategy Design

(I) Purchase of vacc ines

(11) Purchase of equipment

(111) U p d a t i n g t h e e x i s t i n g centres-fa .ce- l is t

(IV) Contr ibu t ion from the l n c d gvernrnen t

) M o b i l h a t i o n of resources with i n t h e community

(VI) Cost recovery cases of esscn t i - , l druae

(VTI) Orientation of e x i s t i n q staff.

FOURTH INTERVENTION: NUTRITTON I?R~GR!IMME

(a ) I n t r o d u c t i o n

Obserrational reports from henlth w o r k e r s in t h e f i e l d

reveal t h a t numerous cases of malnutrition ,nre being treated in

411 hea l th facilities i n t h e LmGwA. z s p e c i - d l y among the 0 - 5 age gror

Yo centre at the moment offers nutritio~ p r y r a m m e and demnn~tratio~.

(b) W j a c t i v e s - -

(I) Reduction i n the i n c r e a s e of m a l n u t r i t i o n cases.

(c ) S~b-QFJective:

1 ) Eat~blishment of nutrition arcl:r:7rnae in 4 1 t h e twelve

hea l th f a c i l i t i e s in Njikok? L=c-! l Government Ares by 1937

(11) I n c e a s e in the number of p ~ o p l c with knowledge of wel l

balanced diet and food p r c p v y ' i o n ,

(111) Bealth Education

( d ) Obbtacl,ea and constraints:

(I) Ron-availability of nutrition 2cmnnstrstion eauipment - tonstraint is money.

(11) Traditional and c u l t u r d factors. (~cological factors).

( e l Strat ,egy Design

(I) Nutrition Education and food demonstration

(11) Purchnse o f food d e m o n s t r s t i o n enuipment

(111) Community m o b i l i s a t i o n

(IV) Health Educat ion t o min imise harmful traditional and

eul turaL f a c t o r s b e l i e f s which ddscourage the use of

va r ious food i t ems i n t h e community.

Ff PTH INTERVENTION: SCHOOL HT .STTI G':Z::?~ICES

Introduction

School health ~ c t i v i t i e s which r c c e i v d bout 20% coverage

r reviously has v i r t u a l l y ceased since t h e in!- roduct ion of f e e s f o r

lruga and minor a i lmen t s t rea tment of s c h n o l children.

'hew i s need to re - in t roduce school hc.?lt 'l -. .rvices i n a l l t h e

~ c h o o l s in the Njikoka Local Governrnovt i?re:~.

(I) To achieve 80% coversge by 1990

Sub-object ivea T

(I) Improvement of t h e hcnlth o f the school c h i l d

(11) Farly d e t e c t i o n of hqcdic?pa

(I 11) Heal th ~ d u c a t i o ~

Obstacles and ~onstraints

(I) NOQ-availabi 11 t y of Equf pmen

( 11) Non-availabil$ty of Transpor t .

(111) Lack 3f drugb. . Strategy Desian

1 Periodic medical examination

(I I) Regulsr (week)y) hygiene In spec t i on

(111) T r e a t m n t of minor a i l m e n t s ~ n d r e f e r r a l

f XV) Heal th Education

(v ) Prrchase of equfprnent and drugs

(VI) Mobflisation of r e s o u r c e s within tho community.

SIXTH InITERVERTION: SUPPLY OF GSSENTI?,L DRUGS

(a) Introdt ic t ion:

S ~ p p l y OF essential drugs i n thc Loca l Government Area

l a hadequate and atorage f a c i l i t ics ir; n. n-exictent.

(b) Objectives:

- (I) Adequate supply of e s s e n t i x l rTrur-;s t o ,311 he-lth fscil : . , i -,

(11) P r o v i s i o n o f a central d r u ~ s t a r e at Local Gov~rnrnen*

Area headquart ere,

( c ) Sub-objective: Distribution of drugs t o per i ac r i11 u n i t s

(d l Obstacles:

(I) Nol-availability of d r u p

( 11) Non-avai labi l i t y o f transport 'or d i s t r i b u t i o n

(TV) Lack of manpower

( e ) S t r a t e g y Deeifz

(I) Bulk purchaae o f e s s e n t i ~ l d r u , ~

(11) Provis ion of Trhsport

(111) Prov ia ion of Central drug n t o r e ~t Local Government

Xrea Headquarters.

(IV) Mobi l i za t ion o f resources w i t h i n the community

(v) Orientation of Pharmacy Technic1 an

(VI) Distribution of drugs to p e r i 7 h e r n l unita.

EIGHTIETH INTERVENTION : TRE ZTMSNT c'- C;.'WMIC DISEASE AND COMMON AILMENT .

(a) I n t r o d u c t i o n :

Treatment of endemic d i s e a s e ~ n d cornz;qn a i lment i s #on6 of

t h e e s s e n t i a l s of Pr imary Heal th Care. The fo l lowing d i s e q s c ~

a r e common i n t h e Local Government' .;rc-i:

( I ) Mala r ia

(11) R e s p i r a t o r y i n f e c t i o n

(111) Tube rcu lo s i s

(IV) Sk in d i s e a s e s

(v) Minor s u r g i c a l cond i t i ons - wounds and c u t s

(b) Objec t i ve s :

TO ach i eve 100% coveraqe of popui : , t ion wi th f a e i l f t 5 e s f o r

t r e a tmen t of endemic d i s e a s e and commqn ~ i l m e n t s

( c ) Obetac les :

(I) Inadequa te equipped c l i n i c s

(I I) Poor d i a g n o s t i c l a b o r a t o r y f n c i l i t i e s

(111) Poor d rug supply

( Iv) Inadequa te t r a i n e d manpower

( v ) Re- t ra ining and o r l e n t ~ t i o n of e x i s t i n g s t a f f .

( d ) Stratem Design

(1) C l i n i c - based r e g u l a r c o n s u l t a t i o n and t r ea tmen t

(11) procurement of c l i n i c equipment i n a l l c l i n i c s

(111) Es tab l i shment of one d i n p o s t i c l a b o r a t o r y i n Local

Government Area Headquy.rtcrs

(IV) Procurement of adequa te s u p p l y of d rugs

No. INTERVENTION OBSTACLES STXTEGY - 1 :rrmunisst ion Vaccines &

Equipment

A v a i l a b i l i t y

La& of E l e c t r i c i t y

and non-funct ioning

co ld cha in system

e c e n t r a l i s a t f o n

utreach

u t i l i s a t ion I

- SOLUTION) ACTIVITIES O M GZTIVES

Parobase of Vaccines 100% Coverage

t 1 Equipmeat by 1990

Cantre 2nd one sub-

cen t r e v e h i c l e s

Purchase of E l e c t r i o i t y

gene ra to r s , p

Prov i s ion of cold room

Prov i s ion of e s s e n t i a l

EPI equipment

Outrearh village

pps t s

Pur dhase of Vaccines

Co l l ec t ion of Vaccine6

Storage of Vaccines

P . r c h s s e of V-ccinat ion

E q u i p e ~ t

Purchase o f Vehicles

Maintenance o f the vehf cles

Purchase of me1 Deployment of driver

. -

Purchase of e l e c t r i c i t y genernt o r s

Cons t ruc t ion of cold room and p l a n t house

Purchase of e s s e n t i a l EPI equipment

Cornmanity mobi l i sa t ion

Health Educatioh

V l s i t Outreach villages

immunisation Sessions

L o c a l Government

Area (LGR) Head-

quar t ers

Local Government

Wea Headquartere

L.G.A. H e ~ d - q u a r t e r s and sub-centre

Health c e n t r e s , schools

Dispensaries & k.berbnF?e

Markets &'Village acjuam

.town h a l l , churches

HEN (TIMING)

uart e r l y

eginning of

u a r t e r l y

11

eginning of rogramme

eginning of ro gramme

Once a month

f o r each

setklement

BY WHOM (RFSPONSISLE)

Local Government

Co-ordinator

Primary Health Care

Co-ordinat o r

Pr imwy Health Care Co-ordinator

WITX VHtT RESOURCES

Fund8 from F.M.O.H.

1nternat iomaT agenc ie s

thambra S t a t e Government

Njikoka Local Gout, au to -

ri i y

The Commuzities in thb Lc1; and N.G.O. ' s - -

Funds from F.M.OIHI

11 11 I 1

Funds from .FIMoOIR, rt 11 II

I* 11 t l

Btaf f t f for o o l d room

- - - - - -

Transport (vehicle)

Fuel, stationery

Heal th Education ma te r i a l s and Audio-visual a i d s

Mass media, town c r i e r Churches, schools, age grades:

'7acsi.1 : ai7.d c a U 5 - L L

-

INTERVENTION

Oral Rehydration (o.R. T. 1

NOn-avai labi l i ty of equipment Consumab3e

r\l

Poor Ut i l i sa t ion

Lack of accammo- datian

STR .ITEGY

Hes l th Educa- t i o n Community m o b i l i s a t i o n

S O L U T I O N ACTIVITIES

Procurement of equipment and 0. R. S o

Health Educat ion Demonstration

Extension of existing b u i l d i n g s

Est2blishrnent of ORT i n a l l t h e twelve hes l th f a c i l i t i e s i n Njikoka LGA by 7988 t o reduce m o r t a l i t y r a t e due t o disrrhe.?.l d i s e s se .

I s c r e x e in the number o f 3:: thods with knowledge of . m d kill i n O.R.S. p r e p ~ r t i o n from present l e v e l of almost 0% i n $987 t o 75% i n 1990

H.C19. Services

,<,

C h i l d lrlelfare

C l i n i c s

4, Family ~ l ~ n n i n g

Lack of Equipment

Transpor t

Lac?; of equiyment

Lack of Druge

Inadequate aanpower

Zack of devices

Cultural and religious factors

Inadequately trained manpower

Outreach

Outrezch

C l i n i c

Hea l th education

Clinic-based .

activities

SOLUTION ACTIVITIES

Purchase of Equipment

Purchase Drugs

O r i e n t a t i o n and

training of Staff.

raining of V-H-W.

Purchase of devices

Health education

Training of ex5 s t i n g staff

OBJECTIVES

Achieve Adeqzste Coverage

Reduce material morta l i ty and morbid i ty

2efl.-~c2 icf yct m o r t a l i t y and m o r b i d i t y

Achieve Adequate Coverage

Reduct'ion of f e r t i l i t y r a t e from 6*5/woman to 4 c h i l d r e d woman. I

TASK

Provide weekly A. N. (S.

Provide facilities for normal d e l i v e r y

Real th Educstim

P r o v i d e weekly i n f s n t wel fa re c l i n i c

Immunization

Mfnof ailment

Community motilization

Training of V.H.WV a

- . - - . . - Provide weekly family planning clinic - - Lecturee In the clinPcs and public placss

WHERE

A l l 12 h'ealth f a c i l i t i e s

A 1 1 12 heslth faci- lities

at 12 health facilities

all 12 health facilities, maxket plaies

L.0. K* Headquarters and a l l v i l l ages

- --

Weekly

A t beginning of programme

weekly

Weekly

at beginning of programme

BY WHOM

Midwives

Health workers

Midwives, Public Health Nurses C.H.0.

C-H.0. Midwives Public Health Nurses

Mfdwives, CIHIOl Public Health Nurse

all health workers

T r a n s p o r t , Drugs Equipment

Delivery h i t T r a n s p o r t a t i o n referral

T r a n s p m t , D T U , ~ Equipment

Mannuals Demonstration milt

Family planning devices

Health Education, manuals, transport

Training m a a u n l s

- -

Nutrition

OBSTACLES

Lack of Nutrition

T r s d i t i o n s l and

Cultural factors

STRATEGY

-

Nutrition

Sducq t ion

SOLUTION ACTIVITIES

Nutrition Demonstration

Community M n b i l i s s t i o n

Bealth T d u c a t i o n

Prevention of

Purchase of 1.~21

demonst r7 . t ion equipment

Community Mobilisation

Heal th Education

--

WHERE

Ih a l l 12 Health ~ d c i l i t i e s

In all Health C l i n i c s

11 0 11 I 1

WHEN BY WHOM WITH WH4T RESOURCES

Weekly Health Workers I n p r e ~ t Account

A t the beginning Trirnnry TIc 21-th of the proqrzrnme Care C o - o r d i n - t o r I I Food dem~nstration

U t e n s i l

G\AS Cooker (portable)

Pot s and Pans, Plates Cutlery

Weekly Realt h Workers Health Education

11 I (1 I) 1 Materials

NO.

-

--

INTERVENTION

School Heal th

Services ': %;hi

2* Iack of Transport

OBST,qCLES

?* Lack of Equipment

3 Lack of Drugs

STRATEGY

school based

C l i n i c s

SOLUTION ACTIVITIES

OBJECTIVES

Improving the health

of the school child

E s r l y d e t e c t i o c af

hand: cays

purchase of Equipmee t I ht L. G, A. Headquarter

P ~ r c h s s e of Vehic le I A t L.G. A. Readquarters

Deployr,ent of -W i v z r P

Purchase of Yuel Z

Maintenance of vehicle I

Purchase of Drugs A t L.G. A. Headquarters

Realth Education

At ~ e g i n n i n $ o f programme

- At ~ e g i n n i n ~ of programme

Weekly

PIR. C. Go-ordinat or school Health I Equipment

BY !\IHOM WITH WHAT R'EsOU'LiCZS -

P13.c. Co-ordinator

L.G. A. A d n i n i s t r ~ t o r

PI HI C. Co-ordinat or

-

Transport

--

PI HI C. Co-ordinator

Public Health Staff Health Education

Materials Audio-

Visual Kids.

INTERVENTION

Supply of ~ssential drugs

OBSTACLES

Non-availability

N o n - m a i l a b i l i t y

of Storage

facilities

on-availability

of t ransport for

d i s t r i b u t i o n

STRATEGY

Bulk Purchase

Essent ia l drug l i s t

SOLUTION ACTIVITIES

Provision of e s s e n t i a l

drug list

Prov i s ion of a C e n t r a l

drug store at L.G.A.

Headquarters

Distribution of drugs

t o per iphera l u n i t s

- OBJECTIVES

Adequate Supply of

essent ia l drugs to all

3e::Jth fscilit ie-

0 k 3 C) a

4 r': z

Water su?ply and

~ n v i r o ~ m e ? t a l

S a n i t ~ t l ~ n

i.

ii.

iii.

iv.

Water supply

Sewage i i sposa l

Refuse 3isposal

Vector and pest

contrc l

OBSTACLES

Lack o f Equipments C

, $

Lack of Chemicals

Inadequate transport

Inadequate manpower

Provision

water

of safe

Health Education

Community Mobili-

sation

SOLUTION ACTTVT'P'LES

Construction of deep wells

Cons t n l z t i o n of S9nit .x-g

S nnlt a r y l a t r i n e

Provis ion of Refuse

disposal sites

Spraying

OBJECTIVES

8096 of Community

with sa fe w - . t e r

3 5 t t c r Sewaffe and

Refuse d i s p o s a l

Reduction o f Vect~rs

and Pests t o a

minimum level

NO.

Treat~ent of endemic d isease

Conmon a . i lmbnt .

erpeci a; :.y

ma1ari.s

e a f d r a t o ~ infections . ... '. D

tuberculosi~ akin

diseases minor surgical

conditions - wounds &

cuts

OBSTACLES

Inadequately equipped

man power

STRATEGY SOLUTION ACTIVITIES

Procurement of

C l i n i c equipments

in 911 c l i n i c s

EstablSshment of

one diaqnoatic

h e a d q u d e r s

Procurement of

adequate supply

of drngs

Re-training

o r i e n t a t i o n of

zx i s t ing staff .

100% coverage

of popula t ion w i t h

f z c i l i t 5 . e ~ f o r

t r e s t m e n t of

endemic disease

and common

ailments

'r- TASK

1 Daily consultation and 4 .. I . t rea tment in all 12

1

Training and Re-training

of serving staff

WHERE

A l l 12 heal th facilities

from LGA Headauartera

~abdratory at LGA

Headquarters C l i n i c

Daily

Weekly

n t beginning of

programme

BY WHOM

~ B ~ / ~ ~ ~ / ~ i d w i v e s

CI HI Assistants

Phmmacy technician

L2Sor&. klng technicinn

Szi lool of Heslth

Technology

C l i n i c equipment

Drugs

Transport .

~ a b o r a t d r ~ equi; 7 .

L a h o r a t o r y r .-:.; ?i .:

Funds frohi

FMOH

Section 5

Budgete I & I1

BUDGET, I

I n t e r v e n t i m 1 - Immunization .

-I. Target A 1 1 children aged (I::.- 24 months i n the f irst year.

population All i n f a n t s 0 - I 2 months i n subsequent years

A l l pregnant women,

C h i l d r e n 0 - 24 montha constitute 53:: of .the p0puI~ti.3

Crude birth rate = 45/1000

Pregnant women conatitute 5% of the ~ o p u l . a t i o n .

Project ion of the target population ic ne P q l l o w s :

Tota l C h i l d r e n 0-2 yr. Infanta Pregn- Year Population (5-399 ( 45g7 000) w omen

(-5% 1

2- Cost of Vaccine

- Cost of vaccine for fully imrnunizin;; one c h i l d = #I. 60

I Total cos t of vaccine -. f o r 5 years p . ? ~ i e d 108,300 x 7.60 -. -<

I --- ~ 7 3 , 2 8 0 I

Yearly coet of vaccine I

cost of vaccine for immunizing 1 pregnant woman = 6 0 ~

T o t a l cost of vaccine 16,600 x 60 ~96,960

Yearly c o s t of vaccine:

1986 22,800 x 60k = 313,320

3. Equipment for cold chain:

2 IWbfrigerators (3.0 lbtres) Unit price q k q x 2 = $1,600

1 Freezer Unit p r i c e ?:GOO = $1,000

24 Ice boxea ( 21 littree) U n i t price 3250 x 24 = $6,000

24 Vaccine carriers Unit price $25 x 24 = $600

2 Electric Generators (4 -5 KVA) Unit p r i c e 3500 z 2 = $7,000

4. Transpor t

1 Toyota Land Cruiser Unit price ?tc!$.000

Fuel: Daily tripe - = 50km

Monthly trips = 50 x 20 = 1000km. -- . 5

Fuel e oneumpt i on = 4 krn/l,i t re 1000

Total fuel requirement/month = s;-- = 250 litres

Cost of fuel = L i t r e = 40k

250 litrss cost #lOO/rnonth

Cost of f u e l per month = '100

Cost of maintenance of vehicle '!I00

T o t a l for transportation c o s t s

Others

(a) Syriges and needles at 3 cents/unit

Total number of children for immunization I 08,300

t t M 11 mothers t i 1 1 I 66,600

5 c o n t a c t s f o r children each

2 contacts for mothers

Total number of contacts 108,300 x 5 . - '1661600 x 2 = 300,0G!0

Cost of syringes/needle = ?03,000 x y c

= +t?7.0?0 in 5 years

( b ) Heal th Education:

Post era, pamphlets, handbills = 75,00O/~ear

16mm Cine project 9697.50

2 epare part kit $52.35 x 2 = $10&.7C

2 magaphone loud hai ler type = 43.34 x 2 = 58G.68

1 Public address s e t -,transistoriaed $252.68 -.-* . -

Transport (vide above)

I - Fuel (same as for 4 above

Maintenance a2 , t,00/vear.

-- . 3

Summary

Capital Expenditure

Cold chain equipment

(Refrigerator, co ld Boxes

generat or)

+l Transport Land Cruiser 8,000

Health Education Equipment 1,162 -- -. - - - -

Total Capital Expenditure 1986

Recurrent Expenditure

Vaccine for chi ldren 0 - 2 yre. 33'?:220

t t fl pregnant mother 13,320

I Fuel and maintenance of vehicle 2,400

I Health Education materials 5,000 ,

Health Fducation Transport cost 2,400

! Totnl Recurrent Expenditure j 986 ~f60,400 $5 400

GRAND TOTAL ~ 6 0 , 4 0 0 $24,762 ..-.

I

Intervention No. 2 ?rsl . .- Rehydration

An average of t w o episode6 of d h r x h o e x per y,:: lr is assumed for . .

every child aged 0 - 5 (13%). 1 ' ' ' , . '

T o t a l number of children a w d 0 - 5

Total number of diarrhoea1 Y p i s o d ~ s

= 57,700 x 2

= 115,400

Treatment of each episode requires 2 p s c k e t s o f

ORS (1,200ml) at 37k each pack T o t a l c o s t of ORS f o r I year

= 115,400 x 37k

- - ~ 4 2 , 6 9 8

~ s s u m i n ~ 60% cov-. pr?ge

Tota l coot - ~ 5 , 6 0 0

Equipment f o r ORT in c l i n i c s - - ,. 3500 per c l i n i c

Total cost ?I500 x 72 = ~6,000

Traneport - (aa f o r Drug supply)

Grant total 1 ?'31,000 per year

C a p i t a l Equipment - - -r6,000

Recurrent ORS - T-F25,000

u p g r a d i n g of existing i n f r a s t r u c t u r e - see Tre-ttment of Endemic Disc3.q

R Equipment

Stationery

Cards and Char t s :

50,000 c h i l d p e n at 5Ok each

15,000 pregnant mothers a t 50l.r ecch

T o t a l Cost - - 32. ., 500

Drugs - see Drug s u p p l y c o s t sheet .I- T ~ t r n drugs f o r 4NC

F e r r o u s s u l p h a t e + Folic :iciO. ( 00 ~ a b s . / ~ r e ~ n a n c y

Cost of s e r v i c e s ~ u l p h n t e Rr P o l i c a c i d $1 per 1000

Total c o s t f o r 15,000 p r e q n a n c i e s = $ 7 500

Tota l cos t f o r 15,000 mothers

Total

Transpor t f o r MCH fi2, 400/yr.

( me1 and m i n t enance) . Grand Tokal ~ 3 4 , 9 0 0 and ?2,9CT

~~t e r v e n t i o n

Capital - N i l

Recur ren t #34,900 e $2 900

Cost of dev3ees - t o be s u p p l i e d by St.>.tc M.O.H.

~ q u i p m e n t f o r each c l i n i c ( ~ r o l l q i n s t r u n e n t s , gloves e t c ) = WjOO

Cost of Equipment for 12 Clinice

T r a n s p o r t a t i o n cost - as f o r W3-

Heal th ~ d u c a t i o n / ~ o m r n u n i t g m o b i l i z q t i o n Eouiprnent

- as f o r i n n u n i z a t i o n

Material ( p o s t e r s , pamphlets + L C ) = f23,OOO

Grand To+rr)?- = .39, OOC

Capital - Equipment ~ l 6 , 000

9 e z u r r e n t - H.E. m a t e r i a l r 7 3 , of):'

Intervention No. 4 - N u t r i t i o n

Food demanst ration equipment "or cent r e ,T

Caaker .,... . .

Pohs & Pans

plates

Cutlery - r !? ,000 erich

Health Education materinls - V7,jOO

Transport - as for MCH - Demonst rz t ion food s t u f f - from imprest.

Grand Total r77,OOO r

Capital - Quuipment *!5,000

Recurrent - Msterial 'r?, 000

Intervention .NO. 6. Adequate supp ly of e s ~ e n t i a l druga

A list of e s m n t i d drugs i a prov i3cd

Estimated coat of essential drugs for yopu!.ztion of 1000 for

T o t a l population of Njikokn LGA 1986 i s 4443,725.

Cost o f drugs/year = F72775 x 443,725 1000

Transport: Vehicle - Fuel 8 M~intenance .E2,400 .._ -- - .

Grand Totnl ~ 7 2 4 , 4 0 0 per y ~ a r

Capital h ' i l

Recurrent - Cast o f druan n122 O0O1

Fuel A maintenance

of veh ic le 22,400

1 Intervention No. 7 - Hater supply and Tnvironnentd Sani tat ion

water digging of wel'la

Labour costs - by community

Personnel 'coets - from Minie t ry ~f ,gric~;lt;ure and i

S a n i t a t i o n

(a) Sewage disposal - Labour cost by community

Personnel c o s t s - I E n i ~ t r y o f Health (Xenl t % 3epartmerit)

(b) Refuse,disposal

Rins - t o be provided by co launi ty

Tipper t o r refuse c o l l e c t i o n ?< disposa l

t o be provided, by LCA.

( c ) Ve tor - Peet Control

Spraying equipment - 6,000

Health Education material 7,000

Capital Eauipment ' ~6,000

Recurrent - Chemical 4,000 1 ~,.'6,000 B. E. material 2,000

Inhervention No. 8. Treatment of Sndenic >iseases snd common Ailrni.nc:

Coat of druks - see drug supply intervention c o s t sheet.

C o a t of Transport - Up~radfnq of existing F a c i l i t i e s

( 1 ) Modf f i c a t i o n & Hodernisat ion of in f r s s t ruc ture

i n 3 existing cen tre s a t 15,000 e3ch (estirnRte)

(3) Provis ion of furniture - .?!10,000

Transporntion costs -

Laboratory at LGA Headquarters - Equipment 0 0

Infrastructure q * d r: I g(1c

Other materi5'1,- o .,

Capital - modification/uprating of s tmcture . .. laboratory equipment/infras t n ~ c turo . .

hecurrent - laboratory consumables

Special Taxget Areas

1. Strengthening of the Health Office

Office Equipment : Calculating machine - I) 0 - H1,OOO .00

Cyclostyling machine 0 . 5,000.00

Storage faci l i t ies - Cabinets & cupboard o a -2,000.00 3'umiture . . e II 3,000.00

ql:.-;71y y, 3T20,OOO. 30 ------- -----...-.-

2. Capital

Recurrent

2. Supervision of Progcamme by Project M,m&;ur 2::. l . . . x i s t an t Transport: 1 Land Cruiser a . 8,000.0~

Fuel and maintenance of vehicle a O 4,800.00 (2000 h-m/month) a 0

Overnight allowance at N O 0 a ;.:::;:!k . . 1,200.GQ

a!.-< , . ;AL ks6,000.00 "- .a --- I- 8,OOO.OQ

Capital ... 8,000

Recurrent ... 6,000

Special Studies (HSR) into implementatfon problems

Stationery ~600.00

Transport ( ~ u e l , maintenance) 92,400.00

Personnel costs (Ffeld workers) ~,OOO.OO

Data analysis 2,000.00

Capi t a1 N i l

Re current fl?O,OOO.OO

3 T r a i n f ng Institutions

Library Infrastructure (~ooks)

Audio v i s u a l / ~ e a c h i n ~ Aids

Books

(Overhead, cine projectors e t c )

Classroom furniture

T r a i n e r T m i n i n g

Capital

Recurrent

- Training of trainers (3) #?,500 each pf4,500.00

Re-Training of CHW (15) Course allowances #5OO each

Training of VHb? (50) Allowance each , . 2,500.00

Orf entation of midwivea (20) pAllswsnce ~ 7 0 0 $+,000,00

Attendance at ~orkshop/~eminars , 2,000.00

T r a i n i n g materials 3,000.00

Capital

Recurrent

Ormd Total fl527,700

+ $35,662

Cspf t a l

Recurrent

Budget I1

EYcpendituqe of W5000,000 a c c o r d --- 51y: ---~...- l a subheads provided in guideline -

1. Upgrading of F a c i l i t i e s ( f f f 0 0 , O O O )

Medff ica t ion t o existing structures 1:3)

Equip ing of centres (3 )

Furniture

Capital Expenditure

Recurrent 11

,3100,000.00

100,000.00

N i l

2. Strengthening of the Health Off i ce ( - f 2 0 , ~ 0 0 )

Off ice ~quipment

Typewrf tere (2)

Stationery

Storage f a c i l i t i e s

Cabinets

Cupboard e t a

Furnf tur e

Tota l

Recurpent 6,000.00

3- *VRW Kits (~50,000)

50 VHkr each year

for 5 years T o t a l 250 VHW

( '~ransfer excess funds (50,000 - l ~ , : j O ( i ,

337,500 t n t r z n s p o r t

and desiqi?;

4. Transport (~52,000)

Vehicle (1) ~uperrtn5on

(2) Distribution of d r u c ~

Motorcycles (4) at H3000.00 each

Bicycles (12) a t R300.00 each

Running costs nnd servicing

Capital !475,000.00

Drugs (~80,000.00) 50 - I n i t fa1 Purchase ~80,000

Revolving fund from proceeds of sales

Total

Capi t a l - N i l

Recurrent ~80,000.00

6. Impreat (~~8,000.00)

Sundries - kerosene, t o r ches : bulb.:

spares for generator e t c

Tyres f o r vehic les , cyc les e t c

Poat ages . - -. -.

~ m e r ~ e n c i e s reserve

C a p i t a l Nil

Recurrent AI 8,000.00

Recnrds and Stat ionery (?~25,000.00)

Record forms

Grmwth charte

Referal cards

Stationary for centres

1,000 each x 12

C a p i t a1 N i l

Recurrent W5,OOO.OO

8. Health Education and community Mobi l i z2t ion (~75,000.00)

Projectors and accessories ~8 ,000 .00

Publ ic address spst em 3,4r)4,00

Megaphonee (3) a t ~500.00 each 1 $30. 00

Posters, charta

Pamphlets, Handbills

T o t a l

Capital #13,500.00

Recurrent 1150Q.00

9. - Consumable s (~35,000.00)

Dr e e s ings ". . .. --

Syringe~ and needles

T o i l e t r i e s , detergents

Insect ic ide

Capi t a1 Ni 1

Recurrent #35,000.00

Tot a1

Infrastructure (~enchee, suits etc)

Microscopee (3) refrigerators

1 Refrigerators (2)

?I. Training (!&0,000.00)

Training of trainers (3) Allowance ~1,500.00 each

Retraining of CHW (15) Allowance R500.00 each

Training of VHW (5) yearly Allowance $450 each

Orientation of midwives (2)

Allowance ff700.00 each

Attendance at ~orkshops/~eminars

Training materials

I T o t a l

I *.

1 12. Training Institution (~35,000.00) 1

I Library infrastructure

Bibrary books

~udiovieual/~e~chin~ aids

(overhead, cine projectors e t c )

Classrrom furniture

T r a i n i n g of trainers

Capf t a1 . H30,000.00

Recurrent 5,000.00

, 1 Studiee (#?0,000.00)

Stationery

I I Transport

1 Personnel costs

I \

(Meld workers, interviews

Data analysis

Capital I N i l

Recurrent WlO,O00.00

Grand total #50O, 000.00

Capi t a1 - #259jOO,OO

Section 6

Monftoring and Evaluation

The f o l l a w i n ~ evaluation indicators should be used f o r monitoring and

evaluation of programme.

(1 ) Heal th S t a t u e i n d i c a t o r s

Infamt m o r t a l i t y r a t e

maternal m o r t a l i t y r a t e

96 of c h i l d r e n 0 - 5 years w i t % n u t r i t i o n a l

e t a t u a below 80% of accepted s t anda rd

( 2 ) Service a c t i v i t y i n d i c a t o r s

Number and percentage of people w i t h access t o

eafe water supp ly

Number of househoZds and % with s n n i t z r y p i t l a t r i n e s

% of pregnant women a t t e n d i n g AIK

11 ( 1 mother attending p a s t n a t a l clinic

'1 of i n f a n t s receiving BCG

DPT

Measlen r a c c f n e

" P o l i o I f

% of p regnan t women r e c e i v i n g t e s t a n u s toxoid

(3) Management Performance Indicators

% of rural health c e n t r e s with 50% of r e o u i r e d s t a n d a r d

drug at any given time.

% of r u r a l health-;.centre with 50% o f r e n u i r e d s t a n d a r d

enuipment i n hand a t any given time

% of community h e a l t h workere receivin~ one .r more

e u p e r v i s o r vieits per month.

(4) Resource I n d i c a t o r s

Community H e a l t h workera per 1,000 people

Midwives per 20,000 people

Phyeicians p e r 100,000 people Cost per out patient contact Per c a p i t a heal th care c a s t

Total Annual cost of PHC

Section 7

Organisation and Management

The o r g a n i s a t i o n a l s t r u c t u r e of the L.G.A. Xeal th Se rv i ce i s

i l l u s t r a t e d i n the diagram.

The main f e a t u r e s which w i l l r e q u i r e stream l i n i n g a r e aa fo l lows :

i. A medical o f f i c e r of Heal t h otlr-ht t o be

appoin ted t o oversee t h e L.G.A. 1s i n d i c a t e d

ti. Staff i n t h e P u b l i c Hea l th Sector are c u r r e n t l y

the staff of t h e S t a t e Res l t h ll~nfigernent Board

serv ing under t h e LGA i.e. d u ~ l c o n t r o l . All

s taf f a t L.G.A. l e v e l should be f u l l y under t h e LGA

Tit. The S t a t e Health Management should withdraw from

LGA except i n t h e running of ~ i s t r i c General H o s p i t a l

iv- Appropria te funding should t hen be made a v a i l a b l e

t o t h e LGA Heal th Sec to r .

The P r o j e c t Manager

U n i v e r d t y PHC Coordinator should f u n c t i o n i n c o l l a b o a a t i o n

wi th an ~ppropriate implementation committee which should i n c l u d e t h e

MOH and key o f f i c i a l e of o t h e r ' s e c t o r . The dqy t o day running of

the LGA Heal th Unit will remain t h e duty of t h e MOH and the head

of t h e P u b l i c Heal th and Environmental S ~ n i t n t i o n Units.