University of Nigeria for Primary Health Care...University of Nigeria Virtual Library Serial No. ......
Transcript of University of Nigeria for Primary Health Care...University of Nigeria Virtual Library Serial No. ......
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.