university of nigeria for primary health care...university of nigeria virtual library serial no. ......
TRANSCRIPT
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.