NATIONAL PRIMARY HEALTH CARE DEVELOPMENT

ii | Page NPHCDA/2019 ANNUAL REPORT

NATIONAL PRIMARY HEALTH

CARE DEVELOPMENT AGENCY

2019 ANNUAL PROGRAMME REPORT

COVER PAGE

iii | Page NPHCDA/2019 ANNUAL REPORT

2019

PROGRAMME ANNUAL REPORT

COMPILED

BY

DEPARTMENT OF PLANNING, RESEARCH &STATISTICS

JANUARY, 2020

NATIONAL PRIMARY HEALTH

CARE DEVELOPMENT AGENCY

iv | Page NPHCDA/2019 ANNUAL REPORT

ACKNOWLEDGEMENT

The 2019 Annual Report of the National Primary Health Care Development Agency

(NPHCDA) was compiled through a collaborative process involving all departments,

divisions, ED’s office and Six (6) Zonal Offices of the Agency. This Annual Report was

prepared based on the National Strategic Health Development Plan (NSHDP) II Pillars as it

relates to NPHCDA - Enabled Environment For Attainment of Sector Outcomes, Increased

Utilization of Essential Package of Health Care Services, Strengthened Health System for

Delivery of Package of Essential Health Care Services and Predictable Financing and Risk

Protection. The tremendous supports of the Executive Director/Chief Executive Officer of

the Agency, Dr. Faisal Shuaib, all the Directors and the top management staff of the Agency

is highly appreciated. Dr. Abdullahi Bulama Garba, Dr. O. Olayinka, Mr. Remi Joseph, Dr.

Nneka Onwu, Mr. Steven Yusuf, Mr. Yibis Gotar, Hajia Iyabo Daradara, Dr. Joseph Oteri and

the Zonal Directors were also very supportive in the Course of preparing the 2019 Annual

Report of the Agency. The collection, compilation and summary of the Annual Report by the

Heads of Division of Planning, Research and Statistics including Dr. Usman Gana Abdulkadir,

Analyst Dare Jimoh, Mr. Rotimi Oyewole, Mr. Olalekan Runmonkun, and all members of Staff

of the Planning, Research and Statistics Department of the Agency who were part of the

process of developing this Annual Report are highly appreciated. We cannot end this piece

without recognizing and appreciating the role of Mrs. Maureen Gopep, Mr. Philip Tanko, Mr.

Mohammed Kamal Rabiu, Dr. Aliyu Muhammad Sabiu, Mrs. Juliet Amuche and Susan Magaji

who are members of the Policy, Planning and Partnership Coordination Division of PRS, and

all other staff of the PRS Department who were involved throughout the process of

developing and finalizing this Annual Report. I must sincerely commend the efforts of the

Clean Up and Finalization Team (Dr. Usman Gana Abdulkadir, Analyst Dare Jimoh, Mr. Rotimi

Oyewole, Mr. Olalekan Runmonkun, Mrs. Maureen Gopep, Mr. Philip Tanko, Mr. Mohammed

Kamal Rabiu, Dr. Aliyu Muhammad Sabiu and Mrs. Juliet Amuche) who worked tireless to

see that this report is ready and on time. Finally, the NPHCDA is profoundly grateful to all

those, too numerous to mention, who contributed to the laudable achievements recorded in

the past year and pray that the Almighty God will Bless and Reward all for their efforts.

Dr. Abdullahi Bulama Garba

Ag. Director Planning Research and Statistics. NPHCDA, Abuja

v | Page NPHCDA/2019 ANNUAL REPORT

Table of Contents NATIONAL PRIMARY HEALTHCARE DEVELOPMENT

AGENCY ................................................................................................................................. ii

NATIONAL PRIMARY HEALTH CARE DEVELOPMENT

AGENCY ................................................................................................................................ iii

ACKNOWLEDGEMENT ......................................................................................................... iv

Table of Contents ...................................................................................................... v

ACRONYMS .......................................................................................................................... x

Our Purpose ....................................................................................................................... xiii

Our Vision ........................................................................................................................... xiv

Mission Statement............................................................................................................... xv

Our Mandate ...................................................................................................................... xvi

Our Motto ......................................................................................................................... xvii

EXECUTIVE SUMMARY...................................................................................................... xviii

INTRODUCTION ............................................................... 1

1.0 INTRODUCTION ............................................................................................................... 2

1.1 OPERATIONAL AND FINANCIAL REPORTS ........................................................................ 3

OPERATIONAL REPORTS ............................................... 4

2.0 ENABLED ENVIRONMENT FOR ATTAINMENT OF

SECTOR OUTCOMES ........................................................ 5

2.1 Leadership & Governance ................................................................................................ 6

2.1.1 Governing Board Meetings .......................................................................................................... 6

2.1.2 Executive Secretaries SPHCBs Quarterly Review Meetings with Executive Director of

NPHCDA ................................................................................................................................................ 6

2.1.3 Technical Assistance Delivery and Leadership Development Academy (LDA) ........................ 7

2.1.4 62nd National Council on Health (NCH) Meeting in Asaba, Delta State .................................. 10

file:///C:/Users/user/Desktop/3rd%20Draft%202019%20ANNUAL%20REPORT%20-%205%20(Autosaved)%20working%20decument.docx%23_Toc32762006







vi | Page NPHCDA/2019 ANNUAL REPORT

2.1.5 Staff Retreat/Succession Planning Workshop .......................................................................... 11

2.1.6 Programmes Implementation Monitoring and Compliance Committee (PIMCC) ................. 11

2.2 Partnership for Health................................................................................................... 13

2.2.1 Engagement with Partners ........................................................................................................ 13

2.2.2 2019 Seattle Declaration ............................................................................................................ 13

2.3 Health Promotion and Social Determinants of Health (Environmental Health) ............. 13

2.3.1 Supplemental Immunization Activities For Polio Eradication ................................................. 13

2.3.2 Routine Immunizations ............................................................................................................. 16

2.3.3 Nigeria Immunization Technical Advisory Group (NGI-TAG)................................................... 22

2.3.4.Other Disease Control Activities .............................................................................................. 26

2.4 Strengthening Primary Health Care Services and Service Delivery ............................... 36

2.4.1 Standard Guidelines for PHC Practice in Nigeria ...................................................................... 36

2.4.2 National Primary Health Care Under One Roof (PHCUOR) Scorecard 5 Assessment in 36

States and FCT. ................................................................................................................................... 36

2.4.3 NSHIP/Additional Funding States (AF States) ......................................................................... 39

2.4.4 Conduct of First Lots Quality Assessment Survey (LQAs) for Ondo State; by World Health

Organization ....................................................................................................................................... 39

2.5 Community Participation .............................................................................................. 41

2.5.1 Northern Traditional Leaders Committee (NTLC) on Primary Health Care Delivery Meetings

............................................................................................................................................................ 41

2.5.2 Orientation training of State Health Educators on Communication for VDPV2 .................... 41

2.5.3 CHIPS Programme Retreat ....................................................................................................... 42

3.0 INCREASED UTILIZATION OF ESSENTIAL PACKAGE

OF HEALTH CARE SERVICES .......................................... 45

3.1 Reproductive, Maternal, Newborn, Child, Adolescent Health Services & Nutrition .... 46

3.1.1 National Emergency Maternal and Child Health Intervention Center (NEMCHIC) ................. 46

3.1.2 First Consultative Retreat .......................................................................................................... 47

3.1.3 Categorization of States ............................................................................................................ 48

3.1.4 First State engagement (Bauchi and Kebbi) ............................................................................ 48

4.0 STRENGTHENED HEALTH SYSTEM FOR DELIVERY

OF PACKAGE OF ESSENTIAL HEALTH CARE SERVICES 54





vii | Page NPHCDA/2019 ANNUAL REPORT

4.1 Human Resources for Health ......................................................................................... 55

4.1.1 Staff Recruitment and Training ................................................................................................. 55

4.1.2 Ongoing/Outstanding Activities for the Year: .......................................................................... 55

4.1.3 N-Power Health Initiative .......................................................................................................... 55

4.2 Health Infrastructure .................................................................................................... 55

4.2.1 Health Facility Assessment for the Southern States ............................................................... 55

4.2.2 2019 Conditional Assessment/Survey for Project under the 2018 Appropriation .................. 57

4.2.3 Health Facility Dashboard ......................................................................................................... 57

4.2.4 Renovation of HQ, Annex, Zonal and State Offices ................................................................ 58

4.2.5 Upgrade of NPHCDA Internet Facilities ................................................................................... 59

4.2.6 Other achievements: ................................................................................................................ 59

4.3 Medicines, Vaccines and Other Health Technologies and Supplies ............................ 60

4.3.1 State Engagements and 2020 Vaccines States Specific Forecast. .......................................... 60

4.3.2 Vaccine and Related Commodities Physical Stock Count in Nigeria from 10th – 23rd June,

2019 ..................................................................................................................................................... 62

4.3 Research for Health ...................................................................................................... 80

4.3.1 Post Campaign Coverage Surveys (PCCS) ................................................................................ 80

4.3.2 Preston Leadership Associates Survey .................................................................................... 81

4.3.3 International Standard Book Number (ISBN) Workshop ....................................................... 81

4.3.4 Health Management Information Systems ............................................................................. 81

4.3.5 Health Informatics Conference (HELINA Conference) in Botswana. ..................................... 84

5.0 PREDICTABLE FINANCING AND RISK PROTECTION

....................................................................................... 86

5.1 Health Financing ........................................................................................................ 87

5.1.1The Basic Health Care Provision Fund (BHCPF) ......................................................................... 87

B. Financial Report ....................................................... 96

B. Financial Report .............................................................................................................. 97

REVENUE: ........................................................................................................................................... 97

EXPENDITURE .................................................................................................................................... 97




viii | Page NPHCDA/2019 ANNUAL REPORT

STAFF PRODUCTIVITY AWARDS/SEND FORTH FOR

RETIRED OFFICERS; NPHCDA ANNUAL SPORTS

COMPETITION AND GIVING BACK TO THE COMMUNITY

....................................................................................... 98

7.0 STAFF PRODUCTIVITY AWARDS/SEND FORTH FOR RETIRED OFFICERS; NPHCDA

ANNUAL SPORTS COMPETITION AND GIVING BACK TO THE COMMUNITY ......................... 99

7.1 Staff Productivity Awards and Send Forth for Retired Officers ................................................. 99

7.1.1 NPHCDA Annual Sports Competition ...................................................................................... 100

7.1.2 Giving Back to the Community ................................................................................................ 101

LIST OF FIGURES

Figure 1 Pictures of Executive Secretary Quarterly Review Meeting ........................................................ 6

Figure 2 Flag Off of Technical Support Programme by HMH Prof. Isaac F. Adewole .............................. 9

Figure 3 Distribution of cVDPV2 in Nigeria .................................................. Error! Bookmark not defined.

Figure 4 National Flag-off of Men A Vaccine .......................................................................................... 120

Figure 5 Showing Cholera CFR in States affected .................................................................................... 28

Figure 6 Reported Cholera Cases by Week .............................................................................................. 29

Figure 7 Error! Bookmark not defined. Preliminary Results of 2019 National PHCUOR Scorecard 5 ....... 37

Figure 8 Conferment of CHIPS Champion Award on the Sultan of SokotoError! Bookmark not defined.

41

Figure 9 Scenes of CHIPS agents in Actions ............................................................................................... 44

Figure 10 Declaration of State of Public Concern on MNCH Death by ED, NPHCDA .............................. 46

Figure 11 Categorization of States based on MCH Indices ........................ Error! Bookmark not defined.8

Figure 12 Health Facility Dash Board .......................................................... Error! Bookmark not defined.8

Figure 13 New NPHCDA Looks ................................................................................................................. 519

Figure 14 Map of States that have Graduated to the DHIS2 Platform .................................................... 61

Figure 15 Disbursement of BHCPF Programmatic Funds through NPHCDA Gateway ........................... 92

LIST OF TABLES

Table 1: Status of TA requests from SPHCBS and their Spread across the PHC Building Blocks ............. 8

Table 2: List of Council Memos Presented by NPHVDA at the 62nd NCH in Asaba, Delta State ............. 10

Table 3: Summarizes SIAs Conducted in 2019 .......................................................................................... 14

Table 4: Summarizes cVDPV2 Isolation from different Sources in 2019. ................................................ 15

Table 5: List of Inaugurated NGI-TAG Members ....................................................................................... 23





ix | Page NPHCDA/2019 ANNUAL REPORT

Table 6: Cholera Outbreaks, Year to Date Comparison Between 2018 and 2019 (Nigeria) ................... 29

Table 7: Outcome of the OCV Campaign .................................................................................................. 30

Table 8: Showing National Cholera Hotspots ........................................................................................... 31

Table 9: Results of Round One MNTE Campaigns Conducted from September to December 2019 .... 36

Annexures:

Annex I: Communique from 62nd NCH in Asaba, Delta State………………………………...103

Annex II: 2019 Seattle Declaration…………………………………………………………………….106

x | Page NPHCDA/2019 ANNUAL REPORT

ACRONYMS

ACTU Anti- Corruption and Transparency Unit

AIDSTAR AIDS Support and Technical Assistance Resources

CHESTRAD Centre for Health Sciences Training Research and Development

CHEW Community Health Extension Worker

CHIPS Community Health Influencers and Service

CHP Child Health Packs

CHSD Community Health Services Department

CMD Chief Medical Director

DHIS2 District Health Information System 2

DPT Diphtheria Pertussis Tetanus

DQA Data Quality Assurance

ELSS Expanded Life Saving Skills

ENC Essential Newborn Care

ERC Expert Review Committee

FCT Federal Capital Territory

FMoH Federal Ministry of Health

GAVI Global Alliance for Vaccines and Immunizations

GF HSS Global Fund Health Systems Strengthening

GIS Geographic Information System

HBV Hepatitis B Vaccine

HCWM Healthcare Waste Management

HERFON Health Reform Organization of Nigeria

HF Health Facility

HMIS Health Management Information System

HSS Health Systems Strengthening

IMCI Integrated Management of Childhood Illnesses

IPDs Immunization Plus Days

IPT Intermittent Preventive Therapy

ISS Integrated Supportive Supervision

LERICC Local Government Emergency Routine Immunization Coordination Centre

LGAs Local Government Areas

LLIN Long Lasting Insecticide Treated Nets

LSS Life Saving Skills

MADEX Mobile Application Data Exchange

xi | Page NPHCDA/2019 ANNUAL REPORT

MCH Maternal and Child Health

MCHIP Maternal and Child Health Integrated Programme

MDA Ministries, Departments and Agencies

MDG Millennium Development Goals

M&E Monitoring and Evaluation

MHGAP Mental Health Gap Action Plan

MMCHIT Mobile Maternal Child Health Information Technology

MNCHW Maternal Newborn and Child Health Week

MNTE Maternal Neonatal Tetanus Eradication

MOU Memorandum of Understanding

MSS Midwives Service Scheme

MTSS Mid-Term Sector Strategy

NBS National Bureau of Statistics

NCZ North Central Zone

NERICC National Emergency Routine Immunization Coordination Centre

NEZ North – East Zone

NGO Non – Governmental Organizations

NICS National Immunization Coverage Survey

NPC National Population Commission

NPHCDA National Primary Health Care Development Agency

NPHCDASP National Primary Health Care Development Agency Strategic Development

Plan

NSHDP National Strategic Health Development Plan

NSIPSS Nigeria Strategy for Immunization and PHC Systems Strengthening

NSMWG National Social Mobilization Working Group

NSHIP Nigeria State Health Investment Project

NTLC Northern Traditional Leaders Committee

NWZ North – West Zone

OPV Oral Polio Vaccine

ORT Oral Rehydration Therapy

RBME Results Based Monitoring and Evaluation

PBF Performance Based Financing

PHC Primary Health Care

PLA Participatory Learning Activity

PMTCT Prevention of Mother to Child Transmission

POA Plan of Action

xii | Page NPHCDA/2019 ANNUAL REPORT

PPH Post-Partum Hemorrhage

PPP Public Private Partnership

PRRINN Partnership for Reinforcing Routine Immunization in Northern Nigeria

RBF Results-Based Financing

RI Routine Immunization

RH Reproductive Health

SC State Coordinator

SERICC State Emergency Routine Immunization Coordination Centre

SEZ South – East Zone

SOP Standard Operating Procedure

SSZ South – South Zone

SWZ South – West Zone

TL Traditional Leaders

TOT Training of Trainers

TT Tetanus Toxoid

UNFPA United Nations Population Fund

VAS Vitamin A Supplementation

VPD Vaccine Preventable Diseases

WCBA Women of Child Bearing Age

WDC Ward Development Committee

WFP Ward Focal Person

WHC Ward Health Centre

WMHCP Ward Minimum Health Care Package

WPV Wild Polio Virus

YFV Yellow Fever Vaccine

ZD Zonal Director

ZTOs Zonal Technical Officers

xiii | Page NPHCDA/2019 ANNUAL REPORT

Our Purpose

To Provide Technical directions for the development of

Primary Health Care in Nigeria

xiv | Page NPHCDA/2019 ANNUAL REPORT

Our Vision

To make PHC Services available to all in Nigeria

xv | Page NPHCDA/2019 ANNUAL REPORT

Mission Statement

To Provide Technical and Programmatic Support to States,

LGAs, and other Stakeholders in the Functioning, Planning,

Implementation, Supervision and Monitoring of PHC Services

in Nigeria

xvi | Page NPHCDA/2019 ANNUAL REPORT

Our Mandate

Providing support to the National Health Policy for the development

of Primary Health Care

Providing technical support for planning, management and

implementation of Primary Health Care

Mobilizing resources nationally and internationally for the

development of Primary Health Care

Providing support for monitoring and evaluation of the National

Health Policy

Promoting health manpower development needed for Primary

Health Care through orientation and continuing education

Providing support to the Village Health System by training Village

Health Workers

Promoting Health System Research by promoting and supporting

problem-oriented health system research

Promoting technical collaboration by stimulating Universities, NGOs

and International Agencies

Providing annual reports on the status of Primary Health Care

implementation nationwide

xvii | Page NPHCDA/2019 ANNUAL REPORT

Our Motto

Making Nigerians Healthy

xviii | Page NPHCDA/2019 ANNUAL REPORT

EXECUTIVE SUMMARY

The 2019 Annual Report Summaries all the various activities and innovative initiatives taken

by the NPHCDA in Conjunction with Partners, to Provide needed support to States, LGAs and

Communities in the Country in the delivery of qualitative Primary Health Care Services, as well

as address various Challenges that confronted the Organization.

The report is in line with the National Strategic Health Development Plan (NSHDP) II Pillars as

it relates to NPHCDA.

• Enabled Environment For Attainment of Sector Outcomes

• Increased Utilization of Essential Package of Health Care Services

• Strengthened Health System for Delivery of Package of Essential Health Care Services

• Predictable Financing and Risk Protection

• In the year under review,the Agency introduced an initiative the National Emergency Maternal

and Child Health Intervention Center (NEMCHIC) following the declaration of a State of Public

Health Concern on Maternal and Child Health in Nigeriaon 8th April, 2019.The Center is a

Coordination Platform on Reproductive, Maternal, Neonatal, Child and Adolescent Health +

Nutrition (RMNCAH + N) activities at Primary Health Care (PHC) and Community levels, with

the goal of reducing Preventable Maternal and Child Mortality in Nigeria by 50% in 2021. With

a VISION of a Country where no Woman or Child dies from Preventable causes and a MISSION

to promote awareness and ensure effective Emergency Response to Maternal and Child

Mortality that addresses the Four (4) delays to care through integrated approach.

Polio Eradication Initiative in Nigeria made remarkable Progress in 2019 with no reported case of Wild Polio Virus (WPV) in the Country since 2016. There was an increase in vaccination and Surveillance reach in inaccessible areas in the Northeast especially in Borno and Yobe States. Despite many successes observed in 2019, there were major challenges encountered. One

such challenge was the sporadic outbreaks of circulating Vaccine Derived Polio Virus type 2

(cVDPV2). The country experienced several outbreaks of cVDPV2 and several cases of AFP

cases of cVDPV2 were reported; 18 AFP cases , 59 cases from enviromental samples, and 9

fromhealthy contacts and a total of 21 cVDPV AFP cases reported, 7 from AFP, 4 from Human

contacts and 10 from enviromental samples. In addition to the several outbreak responses

(OBRs, two NIPDs were planned, but the country implemented one due to resource ramp

down and BMGF sponsored one National Sub-immunizations Plus Days (SIPDs) which has

almost same visibility with a National round. Three Sub-national Immunization Plus Days

(SIPDs) were conducted. Sustaining the gains made through Polio Campaigns was also

threatened by potential immunity gaps as revealed by the upsurge in cVDPV2 cases and low

xix | Page NPHCDA/2019 ANNUAL REPORT

coverages based on Community Surveys and Routine Immunization Lot Quality Assurance

Sampling (LQAS) data. As at December, 2019, the Classification in the database, the total no

of AFP cases was (7129), total no discarded (6743), no of cVDPV2 (18), aVDPV2 (7), WPV (0),

not true AFP (122), Pending Classification (234), Compatible case (5), Ready for NPEC review

(7), Pending adequate AFP cases(171),Pending Inadequate cases (63), inadequate AFP <60

days (21), Inadequate AFP 60-90 days 28. There were also challenges of the non-accessibility

with the estimated Children of 34,845 ,000 unreached in Borno State (Abadan and Marte

LGAs), including settlements along some Islands on the Lake Chad Basin. These Challenges

are due to insurgency, insecurity from kidnapping, Communal Clashes, armed banditry, Cattle-

rustling. Also, other States like Benue, Zamfara, Kaduna were affected.

The year 2019 saw a lot of Outbreaks of Measles, Meningitis, Yellow Fever and cVDPV2 but

these were all contained.

The African Regional Certification Commission (ARCC) Verification Team visited Nigeria from

9th to 20th December 2019, where the team reviewed the National complete documentation,

made corrections to the document, and were posted to Six States – Lagos, Oyo, Abia, Edo,

Ebonyi and Delta States to review State, LGA and health facility level documentation for

Polio Certification.

The NERICC Center made a lot of Progress from 4th July 2017 to date as a Coordination Center.

The first activity in 2019 was the Independent Review Committee meeting that was conducted

on the 7th of January 2019.The Critical Success of the meeting was all the 5 Proposals

Presented to the IRC members were approved making it the first time in the history of Gavi

that 5 Proposals were presented by One Country and all the five proposals were approved.

In February 2019, the NERICC team conducted the Joint Reporting form (JRF) and the National

ToT for the PCV Switch from 2 dose vial to 4 dose vial and all the 36 +1 States participated in

the training in March 2019, all the 36+1 States successfully implemented the PCV Switch

implementation and was completed in the second Quarter of 2019.

NERICC also introduced into the Routine Immunization Schedule Meningitis Serotype A in

August 2019 and Successfully trained HCWs on Men A introduction into RI across the 36+1

States, 774 LGAs and 9565 Political Wards. Over 58,700 HCWs’ Capacity was built. National

Flag-off was done on the 9th August 2019 and State level introductions were completed in all

the 36+1 States. Measles Second Dose was introduced in the4th Quarter of 2019.

Also, in the year under Review, a High-Level Mission by the Gavi Delegation Led by the Gavi

CEO took place in Nigeria. After the renewed engagement with 8 Gavi States, the Country,

Partners and Gavi made a Commitment for a high-level engagement meeting at least once in

xx | Page NPHCDA/2019 ANNUAL REPORT

a year and ended their visit with Ceremonial Launch/Flag-Off of the Cold Chain Equipment

Optimization Platform (CCEOP) support from Gavi to Nigeria.

It is said that “All Day Work without Play Makes Jack a Dull Boy” – on this note, the year 2019

ended with a Staff Productivity Award/Send Forth for Retired Officers/Departmental Talent

Show and Annual Sports Competition in December which has been institutionalized since

2018.

1 | Page NPHCDA/2019 ANNUAL REPORT

INTRODUCTION


1.0 INTRODUCTION

The National Primary Health Care Development Agency (NPHCDA) is a Parastatal of the

Federal Ministry of Health, established by Decree 29 of 1992 to guide and Sustain the

Implementation of Primary Health Care through Federal assistance to States and Local

Governments in the provision of essential health care particularly at the grassroots where

majority of Nigerian lives. The Agency is to support the States and Local Governments in

developing a sustainable system of PHC services that are accessible, affordable and

acceptable, and of good quality through the participation of individuals, families and

communities in partnership with government and non- governmental organizations.

The Agency is charged with the following statutory responsibilities (Functions):

• To provide support to the National Health Policy through reviews and implementation processes;

• To provide technical support to the planning, management and implementation of primary health care in Nigeria; promoting manpower development;

• To mobilize resources, nationally and internationally, for the development of primary healthcare in Nigeria;

• To provide support to the monitoring and evaluation of the national health policy

• To promote health manpower development;

• To provide support for the village health system;

• To promote health system research;

• To promote technical collaboration with universities, non-governmental organizations, international agencies in support of LGAs

• To promote primary health care through advocacy, conferences/ seminars, case-studies, resource centres and reviews, among others.

• With a Motto of “Making Nigerians Healthy”, the Agency has Seven Goals:

• Control Preventable Diseases

• Improve Access to Basic Health services

• Improve Quality of Care

• Strengthen Community Engagement

• Develop high performing Health Workforce

• Strengthen Partnerships

• Strengthen the Institution.

The development Projects of the Agency are all targeted towards achieving the above goals

and contributing to actualizing the health-related Sustainable Development Goals (SDGs).


The Agency’s structure is made up of ten (10) Departments, Six Zonal Offices and the office

of the Executive Director. The Departments are: Planning, Research and Statistics (PRS),

Primary Health Care Systems Development (PHCSD), Community Health Services (CHS),

Disease Control and Immunization, Administration and Human Resources (AHR), Advocacy

and Communication (AC), Logistic and Health Commodities (LHC), Special Duties, Audit,

Finance and Accounts. The Zonal Offices are: North West (Kano), North East (Bauchi), North

Central (Minna), South West (Ibadan), South East (Enugu) and South-South (Benin).

1.1 OPERATIONAL AND FINANCIAL REPORTS

The report will have two components (Operational and Financial Reports) based on the

various activities that were carried out in the Agency in year 2019 and is here presented

according to the Pillars of NSDHP II.


OPERATIONAL REPORTS


2.0 ENABLED ENVIRONMENT

FOR ATTAINMENT OF SECTOR

OUTCOMES


2.1 Leadership & Governance

2.1.1 Governing Board Meetings During the year 2019, emergency and regular Board Meetings took place where issues of the

Agency were discussed and approvals sought. The Governing Board during those meetings

deliberated and made resolutions on Appointment, Promotion & Discipline Matters rand

also received and reviewed Financial Reports.

2.1.2 Executive Secretaries SPHCBs Quarterly Review Meetings with Executive Director of NPHCDA The Department of Planning, Research and Statistics (PRS) successfully Conducted First and

Second Quarter ES Review Meetings in Nasarawa (20th – 21st March, 2019) and Anambra (26th

– 27thSeptember, 2019) respectively.

Figure 1: Pictures of Quarterly Executive Secretary Review Meetings with ED NPHCDA

First Quarter Executive Secretary Review

Meeting: 20th – 21st March, 2019 in Nasarawa Second Quarter Executive Secretary Review Meeting:

26th – 27st September, 2019 in Anambra


Executive Secretary Review Meeting with Deputy Governor Anambra, 26th September, 2019

The Executive Director also held an Emergency meeting with the Executive Secretary

SPHCBs on 7th June, 2019 on Local Government Autonomy following the Pronouncement of

LG Autonomy by the Federal government. The aim of the Meeting was to discuss how the

Pronouncement will affect the Implementation of PHCUOR. The outcome of the Meeting

was to watch out as events unfold itself and also to liaise with sister organizations that had

similar structure and working under such conditions already e.g UBEC.

An On – Boarding/Orientation Workshop was conducted for 10 newly appointed ES from 26th

– 27th of August, 2019 with of bringing them on the same page with their Peers and to

acquaint the new ESs with National Policies, Programmes, Interventions and Leadership

Qualities. The Meeting was an eye opener and the ED promised to Sustain it and even

extend it to the existing ESs.

2.1.3 Technical Assistance Delivery and Leadership Development Academy (LDA) The Technical Support Programme (TSP) has delivered technical support to State Primary

Health Care Boards (SPHCBs) through a number of approaches based on context suitability.

These included States on-site Consultation by Technical Officers, dissemination of

knowledge materials, and Peer-to-Peer learning networks since its first TA intervention in

August 2018.

The TSU, as at October 22, 2019 has collaborated with officers within and outside the Agency

to deliver 51 targeted on-site technical assistance to 24 requesting States. The interventions

cut across different PHC building blocks such as Governance and System Strengthening,

HRH Management, Infrastructure and Equipment, Commodity and Supply Chain, Financing

for PHC, Service delivery, Information & Research.


Table 1: Status of TA requests from SPHCBS and their Spread across the PHC Building Blocks

Description Total No. of requests and Status

PHC Building

Blocks

No. of States No. of unique TA

request

Not Ready for

support

Delivered Total

Governance and

system

strengthening

29 6 29 30 58

Financing for PHC 4 3 13 8 21

Information and

Research

1 1 6 6 12

HRH

Management

1 1 4 7 11

Commodity and

Supply chain

20 2 0 1 1

Service Delivery 1 1 1 0 1

Infrastructure

and Equipment

10 8 1 0 0

Community

Services

0 0 0 0 0

Total 20 52 105

The technical support program has delivered technical assistance to 25 States in Nigeria

NPHCDA set up the LDA to build a Cohort of Staff equipped with the requisite Leadership

and Management Competencies to coordinate effective TA delivery to SPHCBs. The LDA was

structured as a management Fellowship Programme which deploys varying Capacity

building interventions to develop a Cadre of in-house workforce skilled in Management,

Problem-solving, Decision-making, and implementation Support.

Thirty (30) NPHCDA Staff from across the Headquarters and Zones were selected from those

that passed the prerequisite competency test to become the first cohort of enrolees on the

Leadership Development Academy. Six learning approaches were utilized to deliver the


curriculum, which include: in-class sessions, external rotations, mentorship, e-learning,

learning tour and a culminating Capstone Project.

Figure 2: Flag Off of Technical Support Programme (TSP) by HMH Prof. Isaac F. Adewole

Having gone through all the learning approaches designed for the LDA, the enrolees

successfully graduated in November 4, 2019. Also, the capacity of the enrolees has been built

to be able to support the SPHCBs in delivering Technical Assistance.

First Cohort Leadership Development Academy

Grandaunts

Executive Director, Dr. Faisal Shuiab

Making Speech at Graduation of First

Cohort of the Leadership Development

Academy


2.1.4 62nd National Council on Health (NCH) Meeting in Asaba, Delta State

The Agency attended the 62nd NCH with the theme “Consolidating the Journey towards

Achieving Universal Health Coverage” held from 9th – 13th September, 2019 in Asaba, Delta

State where NPHCDA Presented Four (4) Council Memos as in the table below:

Table 2: List of Council Memos Presented by NPHVDA at the 62nd NCH in Asaba, Delta State


Honourable Minister and State Minister of Health

and Other Dignitaries at 62ND NCH Meeting Asaba,

Delta State; 9th – 13th September, 2019

Ag. Director PRS Presenting NPHCDA Council

Memos at NCH Meeting Asaba, Delta State; 9th –

13th September, 2019

Communique of 62nd NCH Resolutions (See annex I)

2.1.5 Staff Retreat/Succession Planning Workshop In the year under review, a retreat for all Agency Staff both in the Headquarters and the

Zones took place from January - May 2019.

Due to the large number of retirees and the Vacuum created, management in its wisdom

conducted a Workshop on Succession Planning for Staff in August, 2019.

Also, a 2-day retreat for Senior Management Staff of the agency took place in Abuja on 30th

October, 2019. The engagement provides an opportunity to appraise and align on the

agency’s vision. The staff also brainstormed on key Strategies to Strengthen & Optimize the

agency’s programmes and priorities and address barriers to optimal program effectiveness.

2.1.6 Programmes Implementation Monitoring and Compliance Committee (PIMCC) In a bid to forestall accountability in the Agency especially as regards Staff participation in

Programmes, the ED inaugurated the PIMCC on the 17th of September, 2019 to serve as a Watch Dog

over Programme Officers and Staff. The Committee has the mandate to ensure that all Programmes

are carried out as at when due and track Staff postings on the field of assignment.


Their ToR included the followings:

TERMS OF REFERENCE (ToR)

1. To ensure that appropriate calibre of staff are deployed for all field activities

2. To ensure Equity, Fairness, Transparency and Accountability in the execution of field

activities

3. To ensure appropriate and timely Reporting of program performance including individuals

ODK report and the general programmatic report.

4. To ensure that only authorized staff members participate in field activities except where

partner’s involvement or other experts are required.

5. To ensure proper monitoring of all staff participation in field activities with the aim of

recommending sanction for non-compliance.

6. To ensure committee submit monthly Report to the Executive Director / CEO

Membership included Union members, all Union Chairmen and Admin Officers of the Zonal Offices

and a legal officer.

Executive Director Dr. Faisal Shuiab, some Directors with Members of the Programmes Implementation Monitoring and Compliance Committee at their Inauguration: Abuja; 17th September, 2019


2.2 Partnership for Health

2.2.1 Engagement with Partners During the year under review, NPHCDA had several engagements with development and

Donor Partners – WHO, UNICEF, BMGF, CDC/AFENET/NSTOP, SOLINA, CHAI, EU–SIGN, e-

HEALTH AFRICA, Gavi, UNFPA etc. The Objective of the various engagements were to Support

NPHCDA to achieve its Mandates and were fruitful and led to series of Collaborations.

2.2.2 2019 Seattle Declaration A 2-day meeting on Human Capital Development (HCD) with focus on Primary Health Care

(PHC) was convened by the Aliko Dangote Foundation (ADF), Bill & Melinda Gates

Foundation (BMGF) and the Nigeria Governors’ Forum (NGF) on 12th and 13th November 2019

in Seattle, Washington, USA. The meeting was aimed at fostering deeper understanding of

States government’ development agenda within the context of the HCD and PHC

framework and to harvest Perspectives to better inform joint Strategies for Prioritization of

PHC for greater Impact and Progress in meeting the Sustainable Development Goals (SDG)

by 2030.

At the end of the meeting, Governors and the two Foundations made commitments aimed

at Promoting Stronger Collaboration between the Governors, the NPHCDA, Federal Ministry

of Health and Development Partners to move the needle and transform Primary Health Care

(PHC) at the subnational level.

The Outcome of the meeting led to the 2019 SEATTLE DECLARATION with 9 Commitments

towards improving HCD for PHC.

Seattle Declaration (See Annex 2)

2.3 Health Promotion and Social Determinants of Health (Environmental

Health)

2.3.1 Supplemental Immunization Activities For Polio Eradication

2.3.1.1 Immunization Plus Days (IPDs)

The 36th Expert Review Committee on Polio and Routine Immunization (ERC) Calendar,

approved a total of 5 Supplemental Immunization Activities (SIAs) - all were conducted in

2019 using bivalent Oral Polio Vaccine (bOPV). Management Support Team (MSTs), Senior

Supervisors and Crack Teams were deployed for each of the Campaigns to give technical

support to the States and LGAs of posting and to ensure close supervision of vaccination

teams for high quality coverage to be achieved. However, some of the SIA States surveyed

achieved >=90% Coverage as shown in the LQAS results of 2019.


Table 3: Summarizes SIAs Conducted in 2019

Many States were evaluated during the rounds using LQA Survey and States and LGAs that

failed were asked to repeat the round according to SOPs.

2.3.1.2 Vaccine Derived Polio Virus 2 and Outbreak response to circulating

vaccine derived Polio Virus Type 2 The ERC approved SIAs Calendar for 2019 was disrupted with the Outbreak of circulating

Vaccine Derived Polio Virus Type 2 (cVDPV2) in some States. These viruses were isolated

from different sources including Acute Flaccid Paralysis (AFP) Cases, AFP Contacts, Healthy

Children and Environmental Samples at different times of the year. Following series of

VDPV2 Outbreak, which necessitated the use of mOPV2 for response. Nigeria conducted

many mOPV Rounds according to SOP.


Table 4: Summarizes cVDPV2 Isolation from different Sources in 2019.

In 2019, a total of 8 mOPV2 Campaigns were conducted as a response to the persistent cVDPV2 Outbreaks with over 28 cases (from HC, AFP and ES) reported in the last 6 months across 7 States namely; Borno, Kogi, Kwara, Lagos, Ogun, Oyo and Sokoto. See Map below: Figure 3: Distribution of cVDPV2 in Nigeria


As a result of these persistent cVDPV2 Outbreaks, a total of Eight (8) Outbreak responses (OBRs) were conducted using mOPV2 in 2019.They were held in January 26th – 30th (1st OBR), February 9th – 12th (2nd OBR), April 13th– May 7th (3rd OBR in 3 phases), May 18th to 21st (4th OBR in 6 SW states), May 25th to 28th (5th OBR in Breakthrough states), June 15th to 18th (6th OBR in SW states), September 14th to 17th (7th OBR- additional OBR in Breakthrough states) and September 19th to October 15th (8th OBR in Kogi& selected LGAs in Enugu, Anambra and Edo states). Of the total mOPV2 response conducted, only the September response in Kogi and selected LGAs in Anambra, Edo and Enugu States had an LQAS result achieving >=90% Coverage while the May response in South Western States had the lowest with a coverage of 64%. However, the OBR has vaccinated about 81.5million Children.

2.3.2 Routine Immunizations

2.3.2.1 Independent Review Committee Meeting

The first NERICC engagement of the year 2019 was the Independent Review Committee

Meeting that was conducted on the 7th of January 2019. It was a 3-day meeting and the main

objectives of the meeting were:

To review the following proposals submitted by Nigeria to the Gavi Alliance:

• Programme Support Rationale, including the Health System Strengthening (HSS) Proposal

• Cold Chain Equipment Optimization Platform (CCEOP) proposal

• Proposals for Yellow Fever SIA, Measles SIA, and Introduction of Measles Second Dose (MSD)

To review the alignment of the Targeted Country Assistance (TCA) plan submitted by the

Country

The critical success of the meeting was all the 5 proposals mentioned above were presented

to the IRC members by the team and for the first time in the history of Gavi 5 Proposals were

presented by one Country and all the five Proposals were approved.

2.3.2.2 New Vaccine Strategic Task Team (NVSTT) Meetings.

At the Meeting the following resolutions were reached:

Key resolutions from the NVSTT Meetings

• There will be an NVSTT planning meeting before the next fortnightly meeting to ensure proper planning for the new vaccines’ introduction and PCV Switch

• National level sensitization to leverage on the EPI review meetings

• To present a schedule for the cascade training at state level at the next NVSTT meeting – Training team; 18 February 2019

• To make the most recent PCV stock data available to the NVSTT


• To hold further discussions and decide on the modalities for the pre-switch spot check

• To send communication to the states on the switch plans.

• To present the demand generation plan for the PCV switch in the next meeting

• The call for materials to be sent out for the collection to be done immediately after the meeting.

• Create an email for the NVSTT ([email protected])

• Follow up on mapping of partners to activities for the funding of Men A introduction.

2.3.2.3 Optimized Integrated Routine Immunization Services (OIRIS)

OIRIS visit from 28th January to 1st February 2019and March 17th to 21st 2019 to 18 NERICC

Priority States (Jigawa, Kebbi, kano, Sokoto, Katsina, Kaduna, Zamfara, Borno, Yobe,

Adamawa, Bauchi, Gombe, Taraba, Plateau, Niger, Kogi, Nasarawa and Bayelsa States).

OIRIS visits to 18 NERICC priority states (Jigawa, Kebbi, kano, Sokoto, Katsina Kaduna,

Zamfara, Borno, Yobe, Adamawa, Bauchi, Gombe, Taraba, Plateau, Niger, Kogi, Nasarawa

and Bayelsa states). The first and the 2nd quarter visits were jointly conducted with NPHCDA

Staff from the Southern States and it serves as a learning visit. The idea was for them to

domesticate the concept in their States.

2.3.2.4 Mini EPI Review Meetings

Mini EPI Reviews were conducted by NERICC team in Bayelsa, Gombe and Katsina supported

by CDC/AFENET/NSTOP.

2.3.2.5 Joint Reporting form (JRF) and the National ToT for the PCV Switch from 2 dose vial

to 4 dose Vial

In February 2019 the main activities conducted by the NERICC team were the Joint Reporting

form (JRF) and the National ToT for the PCV Switch from 2 dose vial to 4 dose vial and all the

36 +1 States participated in the training and in March 2019 the main activity conducted by the

Centre was the State level training on PCV switch that started in the second week of March

2019.

Objectives of the PCV switch included:

• To update the knowledge of State EPI managers and health workers on Pneumococcal Diseases and Pneumococcal Conjugate Vaccine (PCV) 4-dose vial presentation.

• To train state EPI managers & health workers on vaccines accountability (proper PCV 4-dose storage, safe handling, administration, AEFI and waste management).


• To build the capacity of state EPI managers and health workers on the application of the Multi Dose Vial Policy (MDVP).

• To improve knowledge and skills of state EPI managers & health workers on how best to communicate with caregivers and community leaders, and improve demand for immunization and PHC services.

Key achievements:

All the 36+1 States successfully implemented the PCV switch based on the above objectives

and the PCV switch implementation was completed in the second Quarter of 2019.

2.3.2.6 Engagement Meeting with Low Performing LGAs

This took place in Kaduna in the month of May from 13thto 24thMay 2019. Over 40 LGAs and

290 participants from the States were engaged.

The goal of the engagement was Primarily to identify the Specific Challenges of the poor

performing States and design interventional strategies aimed to address the identified

challenges and improve the overall performance of the LGAs.

The Meeting had the following Objectives:

• To provide feedback from National to states on RI performance using the results of the RI LQAS (Q4 2017 – Q1 2019)

• To share lessons learned and best practices from good performing LGAs

• To understand LGA specific challenges responsible for poor RI performance and proffer solutions to address identified challenges

• To develop LGA specific actionable solutions detailing KPI’s, responsible persons and timelines to improve RI performance

• To provide feedback on functionality of LERICCs including RIOs, review ToRs and chart way forward

• To obtain a renewed commitment on improving RI from poor performing LGAs


Cross section of Participants at the Engagement Meeting in Kaduna; May 2019

2.3.2.7 Engagement Meeting with Medium and High Performing States of NERICC

Strategies – 19 States (3 from NCZ and 16 from the South) were engaged in July in Awka

Anambra State.

Over 150 Senior Officials from the States were engaged and NERICC concepts and Strategies

were presented to them. Three States (Oyo, Kwara and Benue) were mandated to

inaugurate SERICC in their States, while others were given an option to consider

establishment of SERICCs in their States.

2.3.2.8 Introduction of Men A into RI Schedule

In August 2019, Meningitis serotype A was introduced into Routine Immunization Schedule.

Objective:

To update knowledge of immunization officers at all levels on Meningitis disease and its

surveillance, build their capacity on handling and administration of MenA Vaccine

Achievement:

Successful training of HCWs on MenA introduction into RI across the 36+1 States, 774 LGAs

and 9,565 political wards.

Over 58,700 HCWs’ capacity was build based on the above objectives


National Flag-off was done on the 9th August 2019 and State level introductions were

completed in all the 36+1 States.

Figure 4: National Flag off of Men A Vaccine

Executive Director and Traditional Rulers during Men-A

National flag-off in FCT: 9th August 2019 Dr. Faisal Shuaib ED NPHCDA Administering of

Men A Vaccine

2.3.2.9 Joint Appraisal Report (JAR)

Approach to Gavi Joint Appraisal for 2020 has been developed and presented to NERICC

2.3.2.10 Measles Second Dose introduction into RI Schedule

On 14th of November, 2019, the Federal Government Successfully through NPHCDA

introduced Measles Containing Vaccine (MCV2) Second Dose at 15 Months into the Routine

Immunization Schedule. Apart from the usual first dose of Measles at nine (9) months old,

all Children will be vaccinated at 15 months with a Measles Vaccine SECOND DOSE. The

SECOND DOSE of Measles Vaccination is given to every Child at 15 months as a Second

opportunity to fully protect Children against the deadly Measles disease.

2.3.2.11 RI-RMNCH Programme Assessment for Performance management & Action (PAPA)

Planning meeting, NToT and implementation have been successfully executed in all the Q3

PAPA States and findings disseminated to all the relevant stakeholders. PAPA LQAS for first

to 3rd Quarters were successfully conducted and disseminated.


2.3.2.12 JAR development

The draft JAR has been completed and to be shared with core Group members for

comments and inputs before presenting to ICC for endorsement.

2.3.2.13 Gavi Programme Capacity Assessment

This simply refers to assessment of the Country’s capacity to implement and oversee Gavi-

supported programmes. It is a periodic assessment and is in line with the Gavi’s

Transparency and Accountability Policy.

Key areas of this assessment included:

In-country Financial Mechanism for receiving Gavi support.

Structures that oversee the use of Gavi support

• Engagement meeting with Gavi 8 States.

The 8 States were selected by Gavi for an extended support in the form of HSS, the States

are currently developing their HSS Proposals. The States are: Kebbi, Katsina, Zamfara,

Jigawa, Taraba, Gombe, Niger and Bayelsa.

Mock review meeting in Kano was concluded successfully and proposals submitted to Gavi

and endorsed by ICC. Now awaiting IRC review proposed for 2020.

• High Level Mission by the Gavi Delegation led by Gavi CEO After the renewed engagement, the Country, Partners and Gavi made a commitment for a

high-level engagement meeting at least once in a year.

The aims included:

• Appreciate the effort the FGoN is making in increasing the funding for Immunization and PHC System based on the agreed commitment between Gavi and FGoN

• Reiterate the Commitment of Gavi on the implementation of the agreed accountability framework between FGoN and Gavi.

The key activities during the visit included but not limited to the following:

Courtesy visit to the Honourable Minister of Health (HMH)

Meeting of the Inter-Agency Coordination Committee (ICC)

Meeting with Honourable Ministers of Health, Finance, Budget and National Planning


Courtesy visit to Mr President

Ceremonial Launch/flag-off of the Cold Chain Equipment Optimization Platform (CCEOP)

The meeting was successfully executed as planned and the expected outcomes achieved.

2.3.3 Nigeria Immunization Technical Advisory Group (NGI-TAG)

2.3.3.1 NGI-TAG General Meeting on Introduction of HPV Vaccine into RI

NPHCDA, in July of 2017 requested the advice of the NGI-TAG on the introduction of HPV

Vaccine into the RI System as well as the type of vaccine to use if it were to be introduced.

The HPV disease working group was then formally inaugurated to gather all evidence

required to come to a decision. After over 8 DSWG meetings, the group finally presented it

findings to the general house on the 10th of April 2019 at the NGI-TAG General meetings and

the following were recommended to the FMoH/NPHCDA:

Nigeria should introduce the HPV Vaccine in its immunization programme in line with the

proposed 2021 timelines in the Nigeria Strategy for Immunization and PHC System

Strengthening 2018 – 2028. The HPV introduction should target age group 9 – 14years.

The Country should consider introduction of the HPV Vaccine in both sexes (Boys and Girls)

with a phased approach initially targeting Girls - this is due to the burden of Cancer of Cervix.

In the medium to long term, the Country should improve on its immunization financing

status and consider inclusion of HPV schedules for boys.

Based on the appraisal of the Vaccine products on efficacy, prevalence of serotypes in

Nigeria, added protection against genital warts and duration of protection; cost per fully

immunized and cold chain capacity, it is recommended thatQuadrivalent HPV Recombinant

Vaccine should be the vaccine of choice

The Nigeria Immunization Programme should use the following Strategies for HPV

introduction:

• Facility based

• Outreaches (in Schools and out of Schools)

2.3.3.2 Inauguration and Orientation of the new and returning NGI-TAG

members (15th October 2019) The members were formally inaugurated by the Minister of Health, Dr. Osagie Ehanire on

the 15th -17th of October 2019. In addition, orientation of all members was conducted on the

16th and 17th of October 2019.


Table 5: List of Inaugurated NGI-TAG Members

S/N Names Position Address

Prof. Ibrahim Abdu-Aguye Chairman Clinical Pharmacologist

Prof. Obehi Okojie Core Member Professor of Public Health,

Prof. Abdullahi

Mohammed

Core Member Clinical Pathologist

Prof. Habib A. Garba Core Member Infectious and Tropical Disease

Physician/Epidemiologist

Prof. Uche Ozumba Core Member Medical Microbiologist

Rev. (Prof). FolaTayo Core Member Pharmacologist/Toxicologist

Dr. Kabiru Mustapha Core Member Public Health Expert

Dr. Dorothy Omono

Esangbedo

Core Member Paediatrician

Dr. Mairo Hassan Core Member Gynaecologist

Dr. Idris N. Muhammad Core Member Immunologist

Dr. Mustapha Muktar Core Member Health Economist

Dr. Esimai Olapeju

Adefunke

Core Member Community Health Physician

Dr. Muktar Gadanya Core Member Public Health Physician,

Dr. Chinedu Simeon Arua Core Member Consultant Radiation and Clinical

Oncologist/Epidemiologist


Dr. Nwagbo Douglas Core Member Medical Statistician

Dr. Adedayo Adeyemi Core Member Medical Statistician

Prof. Augustine

IsikhuemenOmoigberale

Core Member Paediatrician

Dr. Ben Ayene Non -Core

Member

Public Health Expert

Dr. Abubakar. D. Tswanya Non -Core

Member

Dermatologist

Dr.Ango Umar Muhammed

Non-Core

Member

Clinical Epidemiologist

21 Dr. Peter Clement Liaison Officer Country Representative

World Health Organization (WHO)

22 Dr.ModiboKassogue Liaison Officer Immunization Manager (UNICEF) Nigeria

23 Dr.Omotayo Bolu Liaison Officer Director Immunization Programs US CDC

24 Dr.Chizoba Wonodi Liaison Officer Nigeria Country Director

International Vaccine Access Center

(IVAC) at the John Hopkins School of Public

Health

25 Dr. Owens Wiwa Liaison Officer Country Director

Clinton Health Access Initiative (CHAI)


2.3.3.3 NGI-TAG General Meeting on Introduction of Rotavirus vaccine into RI (18th October

2019)

Objectives of the meeting:

To deliberate on the NPHCDA request on a new Rotavirus recommendation

To review the previous Rotavirus Vaccine Introduction recommendations

To review new evidence and data on Rotavirus vaccine products and proffer

recommendations

The group met on the 18th of October 2019 to deliberate on the request sent by the FMoH/

NPHCDA on the need to review its previous recommendation on the type of Rotavirus

Vaccine to be introduced into RI considering new information on the different product types

now available. The Rota Disease Working Group was then formally inaugurated to gather

and review all the new information on the different product type to enable the group make

a final decision.

2.3.3.4 NGI-TAG Emergency Meeting on Rotavirus vaccine introduction into RI (28th

November 2019)

Objective of the meeting:

To review the Rota Disease working Group draft recommendation on Rotavirus vaccine

introduction into RI

To proffer a recommendation to the FMoH/NPHCDA on the type of Rotavirus vaccine to be

introduced into RI

To draft the recommendation, note to Honourable Minister of Health

After 2 meetings held by the Rotavirus Disease Working Group, a general meeting was held

on the 18th of November 2019 at Valencia Hotel, Abuja, with 16 members present including

the Chairman of the group, and the following recommendations were made concerning

Rotavirus vaccine and submitted to the FMoH:

It was the decision of the NGI-TAG to resubmit the previous recommendation of Rota Vac as

the preferred Rotavirus vaccine choice for Nigeria.

To introduce Rota Vac vaccine into the expanded program on immunization

To establish a Surveillance mechanism to determine the background rate for intussusception

and monitor post introduction


To avoid delays of forwarding NGI-TAG recommendations in the future

To improve the sanitation practices and treatment of diarrheal diseases

ACHIEVEMENTS OF THE GROUP

NGI-TAG is one of the globally recognized and functional NITAGs.

•Despite the challenges, the group achieved all its objectives of setting it up.

•Training and Improvement of skills to ensure evidence-based decision making

•Development of Green book and Strategic Plan

•Provision of recommendations based on various Questions posed by FMoH/NPHCDA

CHALLENGES

•Permanent and equipped NGI-TAG office

•Paid access to scientific literature and journals

2.3.4. Other Disease Control Activities

2.3.4.1 Meningitis A

Neisseria Meningitidis is the leading cause of bacterial Meningitis and other serious

infections worldwide. Nigeria has Twenty-Six of its Thirty-Six States and the FCT along the

Meningitis Belt. So far, the Country has conducted 4-phased Meningitis Campaign to control

CSM using Men Afri Vac from 2011 to 2014 targeting persons aged 1 to 29 years of age.

Due to the high burden of the disease amongst under five children and following the WHO

recommendation of conducting Campaign after introduction of Meningococcal - A

Conjugate Vaccine into the Routine Childhood immunization, Nigeria planned to implement

a follow up Campaign targeting children 1 to 5 years (North West and North East States) and

1 to 7years to reach the cohort of children that were born after the completion of previous

Campaigns.

The overall goal of the 2019/2020 Men A Campaign was to eliminate epidemics of

Meningococcal Meningitis due to Sero Type A from Nigeria by vaccinating at least 95% of

Children in States with high disease burden.

27 | Page NPHCDA/2019 ANNUALREPORT

Other activities:

Supportive Supervision to Measles/Yellow Fever Laboratories in Gaduawa and Maitama. 8th

– 9th August 2019

Participated at the Integrated Disease Surveillance and Response (IDSR) review and update:

August 25th -31st 2019 in Lagos

Short Term, Medium Term and Long-Term Prospects for Cholera Control in Nigeria review by

Global Task Force on Cholera Control (GTFCC) - November 2019

Meeting of National Committee for the Verification of Measles Elimination in Ilorin- 7th – 9th

October 2019

Northern AEFI cluster training involving 19 Northern states in Kano - 26th – 30th October 2019

New Vaccines surveillance meeting in Abuja- 14th – 16th October 2019.

National Expert Committee meeting on AEFI in Rivers - 18th – 20th November 2019

Participated Mid- term Joint External Evaluation on Nigeria health security - 18th – 22nd

November 2019


2.3.4.2 Cholera

As at October 31, 2019a total of 1,583 suspected cases of Cholera were reported of which 339

were confirmed cases and 22 deaths among suspected cases (CFR = 1.38%) were reported

from Seven States (Adamawa, Bayelsa, Ebonyi, Delta, Kano, Katsina and Plateau) from the

beginning of 2019. Of the suspected cases, 33.3% were aged 1 - 4 years. Among all suspected

cases, 56.3% were Females whereas 43.7% were Males.

Nigeria: January to October, 2019: Epi Week 1 – 43: States/LGAs affected by Cholera with

attack rate per LGA

Figure 5: Showing Cholera CFR in States affected


Figure 6: Reported Cholera Cases by Week

Table 6: Cholera Outbreaks, Year to Date Comparison Between 2018 and 2019 (Nigeria)

ACTIVITIES AND OUTCOMES

Oral Cholera Vaccination Campaign Implementation in Phase O Hotspot LGAs in Nigeria: Nov

2018 – Sept 2019

• Following the National Cholera Hotspot Prioritization Survey and Risk Assessment done in 2018, a total of 105 Cholera Hotspot LGAs were identified using 3 Criteria. These were; active case transmission, high case fatality ratio


and vulnerability index. The LGAs were grouped as High Risk, Moderate Risk and Low Risk and targeted for interventions in the medium term-as part of a multi-sectoral Cholera control plan, with a vaccination plan in 9 phases.

• This proposal is still under consideration by the Global Task Force on Cholera Control (GTFCC) and was due for review in November 2019. However, the urgent situation presented by the then ongoing outbreak in 4th Quarter of 2018 had necessitated the selection of 10 affected LGAs for urgent intervention by Global Task Force on Cholera Control (GTFCC), including the use of OCV (Phase 0).

• The 2 rounds of the Campaigns were conducted between Nov 2018 and Sept 2019 and witnessed massive turn-out in each case. There was high acceptability level of Oral Cholera Vaccine in Nigeria. In most of the LGAs vaccinated, part of the logistics challenges observed was the influx of Community members from non-targeted and nearby LGAs to targeted LGAs.

Table 7: Outcome of the OCV Campaign

Total Population

Targeted

Total Population

Vaccinated

National Coverage

5,189,692

5,244,305

101 %

• Coverage Survey: The aggregated weighted coverage for the 2 LGAs included in the survey in Borno State was 87%

• AEFI was of negligible significance in all the Campaigns

• At present, impact evaluation is yet to be conducted. However, there has not been any reported cases of suspected Cholera Outbreak in any of the LGAs that have been Vaccinated since 2017 except in Maiduguri Municipal Council where there was a high influx of unvaccinated IDPs from other parts of Borno State affected by crises.


Table 8: Showing National Cholera Hotspots

WASH Components

• Since the beginning of 2019 Outbreak, the Water, Sanitation and Yygiene (WASH) intervention, led by the Federal Ministry of Water Resources (FMWR), has been providing motorized Solar-powered boreholes, Sanitation units with Hand Washing facilities, as well as blocks of Latrine compartments in affected States

• House-to-House Hygiene Promotion activities are ongoing in affected Communities of Adamawa State with Water purifiers being distributed to households. As at October 31, 2019, Adamawa State has accounted for 51% of the cases of suspected Cholera Outbreak in 2019

• 170 Water points have been mapped for treatment within the affected LGAs in Adamawa State


• At least 510,663 litres of Water have been Chlorinated in 39 of the mapped water points and this was being carried out daily

• Distribution of Water Purification Tablets were being carried out in some affected Communities of Adamawa and Katsina States.

Others

• Nigeria is also working with other Lake Chad Basin Countries to Strengthen Cross-

border Collaboration for Cholera Control

Challenges

• Inadequate global Oral Cholera Vaccine stockpile which sometimes results in delayed reactive Vaccination Campaigns to contain Outbreaks

• In case of preventive OCV campaigns as planned in the Hotspot Prioritization, it was expected that the 1st and 2nd doses should be concluded in the targeted LGAs and Communities before the onset of the Season. Conversely, due to the limited global OCV stockpile, achievement of this outcome has been a major challenge

• Other identified challenges included personnel and staffing inadequacies especially at subnational levels, security concerns as well as other sundry issues that may be associated with vaccination and mass Campaigns generally

Way Forward

• In addition to the hotspot prioritization which has been planned for review in January 2020, and in response to a call for a multi-sectoral long-term plan for the Cholera Control in Nigeria, a 5-year National Strategic Plan of Action for Cholera Control has been developed. This is to drive a coordinated approach to Cholera Control in Nigeria and this plan currently forms the basis for all cholera control interventions in the country.

• Seven (7) Strategic areas of interventions have been identified as complementary tools for achieving the medium-term goal. These are; Leadership and coordination, Epidemiologic surveillance, Laboratory surveillance, Case Management and Control, Social Mobilization/Risk Communication, Improvement in the Supply of Safe Water, Sanitation and Hygiene and the use of Oral Cholera Vaccine.

• A Critical part of the goal plan was to reduce the incidence and mortality due to Cholera by 67% by the year 2023. This medium-term goal forms part of a larger framework of eliminating cholera in Nigeria by 2030 as part of global target

• Measurable indicators and annual targets have been set for the monitoring and evaluation of each sphere of activity contained in the plan

• Efforts were being made to identify relevant partnerships to conduct impact evaluation on the various Cholera Control Strategies so far deployed as well define research priorities for strengthening cholera control in Nigeria


• Implementation of the 2020 agenda of the just concluded 6thGlobal Task Force on Cholera Control - OCV Working Group meeting held on December 3-4, 2019 in

• Geneva, Switzerland

2.3.4.3 Yellow Fever

Nigeria has aligned with the Eliminating Yellow Fever Epidemics (EYE) strategy to eliminate

Yellow fever from Nigeria by 2026. In furtherance of this and because of the reduced

availability of yellow fever vaccines, Nigeria is staggering its preventive campaigns over the

next 5 years to cover the entire country while also responding to outbreaks.

Activities conducted in 2019 included:

Conduct outbreak investigation together with NCDC and WHO on suspected yellow fever

reported cases including entomology studies

Katsina implemented YFPMVC from 28th sept – 9th oct 2019 (27th sept 2019 in Dan-

musa&Kankara due to the YF outbreak)

YF Preventive mass vaccination campaign in 3 LGAs in Borno state- 11th to 20th December

2019

Yellow Fever outbreak response

Edo (13 LGAs), Delta (1 LGA) and Ondo (6 LGAs) – June/July 2019

Ebonyi (Abakaliki, Izzi and Ebonyi LGAs) and Cross River (Yala LGA) – 8th -18th September

2019

Benue (Ado and Oju LGAs) – 18th – 28th September 2019

Bauchi (Alkaleri LGA)- 13th -17th September 2019

Together with NCDC and Partners, a Yellow Fever risk assessment was done to prioritize

highest risk states for Preventive Campaigns to forestall outbreaks

Preventive Mass Vaccination campaigns planned for Anambra, Ekiti and Rivers in 2020.


2.3.4.4 Measles

2.3.4.4.1 Integrated Measles and Meningitis A Mass Vaccination Campaign

Meningitis A and Measles Mass Vaccination Campaign was integrated in 18 States of the Northern

Zone except Kano and Yobe. Kano had stand alone for Measles and Meningitis A while Yobe had only

Measles Campaign. The target for Measles was 9 – 59 months, while the target for Meningitis A

varied from 1 -5 years and 1-7 years across 25 States. The Campaigns began on the 31st October 2019 in

Kano.

Stand-alone Meningitis A vaccination campaign started on the 6th December 2019 in Imo and Enugu

states. Oyo, Ebonyi, Cross Rivers, Anambra will conduct their Men A mass vaccination Campaign in

2020.

2.3.4.4.2 2019 Measles Outbreak and Responses

Nigeria conducted a measles follow up campaign targeting children 9 months to 59 months between

November 2017 and April 2018. This was in response to the low Routine Immunization coverage and

the suboptimal SIA coverages. Campaign was conducted in four streams. The operational target

population for the campaign was 37,412,277 (GIS for the North and House Hold enumeration

Walkthrough for the South). At the end of the exercise from the administrative data (tally sheet), a

total of 40,044,875, representing 107% of children 9-59 months were given measles vaccine. A total of

5, 391,435 (15.9%) of children received their first MCV during the campaign (zero dose). The post

campaign coverage survey put the national coverage at 87.5%. For the first time, in a measles

campaign 19 States got more than 90% vaccine coverage, among a higher proportion of rural children

36.2% received their first measles dose during the campaign against 26.8% urban children. No marked

gender difference in those receiving the vaccine for the first time.

2.3.4.4.3 Post 2017/2018 Measles Vaccination Campaign

According to the measles situation report for 2018 and 2019, a total of 1,610 and 1,638 suspected

measles cases occurred respectively.

The NPHCDA has supported most of the affected states in responding to these outbreaks through

providing the states with vaccines. The NPHCDA zonal and state offices were leveraged upon to

provide technical support to the states. However, the NPHCDA has conducted some reactive

vaccination in some very high prone areas: The Measles OBR took place in the following States viz;

Yobe, Ogun, Benue, Lagos, Borno, Igabi LGA of Kaduna and Hong in Adamawa.

Conclusion:

Most of the Outbreaks that have occurred were areas where vaccination could not take place due to

security challenges - IDP camps and their host communities. The agency through its vaccine

forecasting for the year 2020 has planned to prioritize preposition of vaccines in these vulnerable

areas.


2.3.4.4.4 Maternal Neonatal Tetanus Elimination (MNTE) Activities in Nigeria 2018/2019

The global Maternal Neonatal Tetanus Elimination (MNTE) target is 2020 and activities are

ongoing towards ensuring the country meets this target. In October 2017, MNTE was

validated in the South-East zone. A pre-validation assessment was conducted in the South-

west zone in May,2017, findings from the assessment identified seven LGAs as high risk in

Oyo state namely Saki west, Saki east, Ibarapa north, Oyo west, Iwajowa, Itesiwaju and

Atisbo. In Ogun state, Itapa community in Remo North LGA was also identified as high risk.

Three rounds of SIAs were recommended in these LGAs. These rounds were implemented

with administrative coverages of 130%, 122%, 133% for Td1, Td2, and Td3 respectively. In Itapa

community, administrative coverages of 185%, 99% and 109% for Td1, Td2 and Td3 was

attained. The high coverage above 100% can be attributed to influx of people from

neighbouring LGAs, Communities, and denominator issues as projected 2006 census was

used. Following implementation of recommended activities in 2018, MNTE was validated in

the South-west zone in May 2019.

A high-risk assessment conducted in the South-South zone identified 94 LGAs in the six

States as high risk. One round was recommended for 94 LGAs in the six states, 2 rounds for

56 LGAs in five states, then 3 rounds for 8 LGAs in one state. NPHCDA with support of

Partners has implemented two rounds as recommended reaching an administrative

coverage as follows; Akwa-Ibom (Td 1 - 112% ; Td 2 - 84%),Bayelsa (Td1 - 95% ; Td 2 72%),Cross-

river(Td 1 – 118% ;Td 2 - 91%),Delta (Td 1 - 97%),Edo(Td 1 - 80% ; Td 2 - 56%)and Rivers(Td 1 -

102%).

A high-risk assessment was conducted for Northern States in March 2019 and 136 LGAs were

identified as high risk in 16 states namely: Kano (3), Katsina (14), Kaduna (3), Kebbi (10),

Sokoto(6), Zamfara (6), Benue (18), Kogi (15), Kwara (10), Niger (7), Plateau (16), Taraba (4),

Yobe (3) ,Borno (19), Bauchi (1) and Adamawa (1). Three rounds of SIAs were implemented

as recommended for these LGAs. National MNTE Northern States (North-West and North-

Central zones) implementation training was conducted on the 9-10th September 2019.

A National workshop with South-East and South-West Zones was conducted to develop Plan

of Action to sustain elimination of Maternal Neonatal Tetanus (5 - 9 September 2019).


Table 9: Results of Round One MNTE Campaigns Conducted from September to December 2019

S/NO STATE

NO OF

LGAs

DATE OF

IMPLEMENTATION

TARGET POP

(15-49YRS)

NO

IMMUNIZED

ADMIN

COVERAGES

1 NIGER 7 14-18TH OCT 433,782 459,336 107.7%

2 KWARA 10 12-16TH OCT 525,947 467,450 87%

3 KANO 3 12-16TH OCT 153,946 156,231 101.7%

4 KEBBI 10 22-26TH SEPT 537,039 499,494 98%

5 SOKOTO 6 27TH SEPT-1ST OCT 292,252 262,019 93%

6 KADUNA 3 21-25TH SEPT 232,190 245,500 98%

7 PLATEAU 16 27TH SEPT-1ST OCT 936,318 827,669 88%

8 BENUE 18 26-30TH SEPT 1,153,643 1,224,189 104%

9 KATSINA 14 20-25TH OCT 933543 684734 72%

10 KOGI 15 23 NOV-1 DEC 837,074 821,780

2.4 Strengthening Primary Health Care Services and Service Delivery

2.4.1 Standard Guidelines for PHC Practice in Nigeria The Agency developed the Standards, Guidelines and Regulatory Framework for PHC

Practice in Nigeria Document for the first time. The aim was to have a Standard and

regulatory document that will hold people accountable. The document has since being

developed and awaiting Printing/Dissemination

2.4.2 National Primary Health Care Under One Roof (PHCUOR) Scorecard 5 Assessment in 36 States and FCT. The Department of Primary Health Care Systems Development (PHCSD) Conducted the 2019

National Primary Health Care Under One Roof (PHCUOR) Scorecard 5 Assessment in 36

States and FCT.NPHCDA and Nigeria’s Governors Forum (NGF) Secretariat with support from

other Partners (PACFaH@Scale (PAS), Health Policy Plus (HP+), Network for Health Equity &

Development (NHED) and Health Reform Foundation of Nigeria (HERFON) conducted the

PHCUOR Scorecard 5 Assessment in September/October, 2019 in the 36 States and FCT. The

goal of the PHCUOR Scorecard 5 Assessment was to Produce an Advocacy tool to help


stakeholders, Health Policy Advisors, political leaderships, governing bodies and managers drive

the changes needed to strengthen PHC systems for optimal performance in their states.

The Objectives were:

To identify areas of strengths, best practices, gaps/weaknesses and challenges in each state

To make recommendations to guide States and partners in targeting support for

improvement

To produce a scorecard as an advocacy tool for engaging policy makers including State

Governors as well as other PHCUOR actors in all States to improve political commitment and

funding for effective Primary Health Care (PHC) implementation to enhance rapid

achievement of Universal Health Coverage (UHC)

To develop, print and disseminate a report that provides a guide for States and the FCT to

request technical support from NPHCDA and partners to improve their performance

Figure 7: Preliminary Results of 2019 National PHCUOR Scorecard 5

NPHCDA – National Primary Health Care Development Agency7

74% 73%

64% 64%

72%

77%

83%

71%

80%

GOVERNANCE & OWNERSHIP

LEGISLATION MINIMUM SERVICE PACKAGE

REPOSITIONING SYSTEMS DEVELOPMENT

HUMAN RESOURCES

FUNDING SOURCES AND

STRUCTURE

OPERATIONAL GUIDELINES

OFFICE SET UP

NATIONAL SUMMARY BY PHCUOR PILLARS SCORECARD 5 (%)


NPHCDA – National Primary Health Care Development AgencyFriday, December 13, 2019

5.SCORECARD 5 PRELIMINARY RESULTS

8

92

66

90

7472

97

84

36

51

40

94

66 66

7

19

58

93

66

7981

69

63

82

97

55

76

56

24

85

97

73

39

72

54 54

67

81

0

20

40

60

80

100

120

OVERALL RESULT OF STATE BY PERCENTAGE (%)

NPHCDA – National Primary Health Care Development Agency

OVERALL STATES PRELIMINARY RESULTS BY PERCENTAGE

9

ZONES STATE SCORES (%) AVERAGE BY ZONE AVERAGE NATIONAL

SOUTH EAST

ABIA 92

79

67

ANAMBRA 66EBONYI 90ENUGU 74IMO 72

NORTH EAST

ADAMAWA 97

67

BAUCHI 84BORNO 36GOMBE 51TARABA 40YOBE 94

NORTH CENTRAL

BENUE 66

54

FCT 66KOGI 7KWARA 19NASARAWA 58NIGER 93PLATEAU 66

NORTH WEST

JIGAWA 79

75

KADUNA 81KANO 69KATSINA 63KEBBI 82SOKOTO 97ZAMFARA 55

SOUTH WEST

EKITI 76

69

LAGOS 56OGUN 24ONDO 85OSUN 97OYO 73

SOUTH SOUTH

AKWA IBOM 39

61

BAYELSA 72CROSS RIVER 54DELTA 54EDO 67RIVERS 81


2.4.3 NSHIP/Additional Funding States (AF States)

2.4.3.1 Project Retreats

Two forms of retreats were organized under the project within the period under

consideration. One for the NPHCDA/NSHIP PIU and the other for the Federal Ministry of

Health (FMoH)/NSHIP PIU. The essence of the retreat was premised around set

objectives/goals aimed to achieve by the project which would contribute to the

improvement in national macroeconomic objectives. To engender creativity, the PIU team

organized a retreat to set project implementation priorities for the year and device steps for

their attainment. The retreat was also used to further sensitize key officials of the Ministry

on Result Based Financing and Performance Management in the health sector.

2.4.3.2 Flag Off/Launch of the Scaled Up LGAs-Health Facilities of Bauchi and Gombe States

In order to increase political buy-in and program visibility and awareness, Gombe and Bauchi

State PIUs organized flag off ceremonies for newly scaled up LGAs. The Launch /Flag off

event focuses on the goals and objectives of the NSHIP intervention, creates awareness on

the existence of the NSHIP initiative in the scaled up LGAs and health facilities.Governors

and traditional leaders present promised to support the project at all levels as they have

witnessed the positive impact has made in the already benefiting communities. Both

governors promised to look into sustainability of the project in their respective states.The

flag off event occurred in the new scale up LGAs of Gombe (Akko and Billiri) and Bauchi

state (Kirfi, Itasgadau, Darazo) from the 18th-20th July 2019.

2.4.4 Conduct of First Lots Quality Assessment Survey (LQAs) for Ondo State; by World Health Organization

The Modified PBF in Ondo State includes replacement of routine quantity verification with Lots Quality Assurance Survey. Quality verification and counter verification continues in accordance with the project design, WHO is now responsible for the conduct of LQAS with a shift in focus from facility-based impact to population -based impact. The baseline for all LGAs was conducted in January this year and first LQAS was conducted in July 2019.Below are the results of the baseline and first survey conducted for the 9 LGAs implementing PBF in Ondo State.


Table 10: Showing NSHIP States LQAS Results

Baseline LQAS Result First LQAS Result


2.5 Community Participation

2.5.1 Northern Traditional Leaders Committee (NTLC) on Primary Health Care Delivery Meetings The 1st quarter meeting was held 2nd April, while the combined 2nd – 4th quarter meeting was held 27th

November. Both meetings were held at General Hassan Usman Katsina House, Kaduna. At the first

NTLC meeting in 2019, His Eminence, Sultan of Sokoto was conferred with the CHIPS Champion

Award. The award was as a result of the Leadership Role His Eminence played in mobilizing

Community members towards a common cause that helps to reduce Maternal and Child Morbidity

and Mortality.

Figure 8: Conferment of CHIPS Champion Award

Conferment of CHIPS Champion Award on the Sultan of Sokoto, Kaduna 2nd April, 2019

During the Second NTLC meeting, the ED, NPHCDA who was represented by Director

Disease Control & Immunization solicited for the sustained support of the Royal Fathers in

Primary Health Care generally with special focus on RI and Maternal and Child Health

interventions while adding that the Agency continue to evolve Strategies to improve and

Strengthen Primary Health Care for the benefit of all Nigerians.

2.5.2 Orientation training of State Health Educators on Communication for VDPV2 A re-orientation training for the key Personnel implementing EPI Communication activities in

the 19 Northern states and FCT was held to hone the Skills of Communication players in

Strategic Communication so as to build Community Trust, ensure effective Mass


Communication of the Outbreak and increase demand for immunization Services. This was in

line with the 36th ERC recommendation that the Programme convenes a Strategic meeting

to address the emerging mass Communication challenges related to VDPV2 Outbreak.

Outcome:

Some of the Outcomes of the meeting were:

• Improved knowledge of Participants in Polio epidemiology, especially VDPV2

• Improved knowledge and Skill of Participants in rumour management and Mass Communication of VDPV2

• State Specific Strategic Communication Plans to address key challenges were developed.

2.5.3 CHIPS Programme Retreat The National Primary Health Care Development Agency (NPHCDA) in Collaboration with

UNICEF organized a two – day CHIPS Programme Retreat in Transcorp Hotel, Abuja from

29th- 30th April, 2019 to review Progress made so far since the commencement of the

Programme in 2018.

Objectives of the Retreat were:

• To review programme activities conducted during the year 2018 challenges encountered and lessons learnt

• To identify and develop strategies for harmonisation and transitioning of existing community health interventions in focus states

• To discuss and brainstorm on scaling up and sustainable implementation in States.


Scenes from the Retreat

Following the development of the CHIPS Programme Information, Education and

Communication (IEC) materials, a two day Photoshoot Session was conducted in Kokona

LGA of Nasarawa State from Tuesday 6th to Wednesday 7th August, 2019 for the materials

with the following Objectives:

• To do a photoshoot with the real CHIPS Agents for the IEC material

• To get appropriate pictures for each scenerio

• To have available pictures for the CHIPS Programme Unit Various Scenarios were discussed and agreed on by the National level team before the

activity. Some of which included CHIPS Agent Counselling a Womanwho is holding a baby

inside a house;A CHIPS Agent trying to teach a mother proper positioning and attachment of

her baby during breastfeeding; A CHIPS Agent completing her data tools; A CHIPS Agent

escorting a Caregiver to the Health Facility etc.


Figure 9: Scenes of CHIPS agents in Actions

A CHIPS Agent escorting a Caregiver to the

Health Facility CHIPS Agent Counselling a Woman

who is holding a baby inside a house A CHIPS Agent completing her

data tools


3.0 INCREASED UTILIZATION

OF ESSENTIAL PACKAGE OF

HEALTH CARE SERVICES


3.1 Reproductive, Maternal, Newborn, Child, Adolescent Health Services &

Nutrition

3.1.1 National Emergency Maternal and Child Health Intervention Center (NEMCHIC) The National Emergency Maternal and Child Health Intervention Center (NEMCHIC) was

established by National Primary Health Care Development Agency (NPHCDA) following the

declaration of State of Public Health Concern on Maternal and Child Health in Nigeria by the

Agency on 8th April 2019. The Center is a Coordination Platform on Reproductive, Maternal,

Neonatal, Child and Adolescent Health + Nutrition (RMNCAH + N) activities at Primary Health

Care (PHC) and Community levels, with the goal of Reducing Preventable Maternal and Child

Mortality in Nigeria by 50% in 2021.NEMCHIC operated only within the last three quarters

(Q2,Q3, Q4) of 2019. The Followings are highlight on the major activities carried out by the

Center in the 2019 Operational Period:

• Operationalization of NEMCHIC

• Consultative Retreat

• Categorization of States based on RMNCAH+N key Indicators

• Development of state engagement tools

• Development of NEMCHIC operational guideline

• Engagement of RMNCAH+N stakeholders

• Development of Monitoring & Evaluation (M&E) framework

• First state engagement (Bauchi and Kebbi)

• Harmonization of state engagement visits and tools under the Optimized Integrated RMNCAH+N and Immunization Supportive Supervision (OIRISS)

• Second state engagement (Katsina, Combe and Taraba)

• Engagement with partners:

• REAKTHROUGH ACTION – NIGERIA for harmonization and standardization of community engagement and WDC tools

• e-Health Africa


Figure 10: Declaration of State of Public Concern on MNCH Deaths

Executive Director, NPHCDA declaring a State of Public Health Concern on Maternal and Child Deaths with some Traditional Rulers; Abuja, April 8th 2019

3.1.2 First Consultative Retreat The first consultative retreat successfully held on 8-10th May 2019 at Ajuji Hotel, Abuja. The

retreat was the most immediate step taken after the emergency declaration to secure the

buy-in of stakeholders and partners across RMNCAH+N space into NEMCHIC objectives and

goals.

The Objectives of the Retreat were:

• To appraise the situation of Maternal and Child Health for each state including a review of the progress and status of the states’ RMNCAH +N operational plan in line with SSHDP and NSHDP

• To identify enablers and bottle necks to reducing maternal and child mortality in the different states

• To align on priority interventions and stakeholder’s ownership of interventions.

• To introduce the concept of National Emergency Maternal and Child Health Intervention Centre (NEMCHIC) and develop Terms of Reference for State coordinated platform.

• To facilitate peer to peer learning amongst the high and low performing states towards reduction of maternal and child mortality.

• To plan for the conduct of NEMCHIC technical and advocacy visit to states in the low category of RMNCH+N performance


3.1.3 Categorization of States This Consultative retreat was immediately followed with categorization of the states according to

two key MCH indicators – Skilled Birth Attendant (SBA) and under-5 Child Mortality.

Accordingly, all the states of the federation were categorized according to levels of performance on

MCH indices based on data from 2018 NDHS report and 2019 Q1 PAPA survey. The categories are Low

1- States (Very Poor) Low 2 - States (Poor) Medium 1 - State (average) Medium 2 - States (below

average) and High State (Good), see Fig. below.

Figure 11: Showing Categorization of States based on MCH Indices

3.1.4 First State engagement (Bauchi and Kebbi) The Center prioritized engagement with States that fall under Low 1 (very poor) and has so

far covered five States (Bauchi, Kebbi, Katsina, Gombe and Taraba) under this category.

Bauchi and Kebbi were the first States engaged. The engagement was carried out from 30th

June – 6th July 2019. The main goal of the State engagement visit was to mobilize

Stakeholders at all levels of the State for Emergency Response and Commitment towards

achievement of 50% reduction in Maternal and Child Deaths by 2021. Each State was engaged

by carefully constituted NEMCHIC teams, with State and Zonal memberships.

High States (Good) Medium 2 States (below average) Medium 1 States (average) Low 2 States (Poor) Low 1 States (Very poor) No data

RIVERS

FCT

ANAMBRA

ENUGU

AKWA IBOM

ADAMAWA

ABIA

BAUCHI

BAYELSA

BENUE

BORNO

CROSS RIVER

DELTA

EBONYI

EDO

EKITI

GOMBE

IMO

JIGAWA

KADUNA

KANO

KATSINA

KEBBI

KOGI

KWARA

LAGOS

NASARAWA

NIGER

OGUN OND

O

OSUN

OYO

PLATEAU

SOKOTO

TARABA

YOBE

ZAMFARA


Key Successes recorded from Kebbi State:

• Establishment of SEMCHIC in the State, partners in Kebbi state also pledged technical support to the SEMCHIC

• Establishment of LEMCHIC

• Setting up of a Commission on revitalization of PHCs

• Flag off of distribution of delivery and other lifesaving equipment for 361 PHCs in 361 Wards in line with the upgrade of one functional PHC per Ward.

• Kebbi state government committed to ending preventable maternal and under- five mortality in the State

• The traditional institutions support towards ending preventable maternal and under- five mortality in the state through aggressive community engagement and sensitization

• Commencement of implementation of community engagement strategy for improving ANC, SBA and care of Under 5 children

Advocacy Visit to Deputy Governor Kebbi State Advocacy visit to HRH Emir of Argungu(Kebbi State)


Advocacy Visit to Dep. Gov. Kebbi State Director Advocacy Visit to HRH Emir of Arugugun

Kebbi State

Key successes recorded from Bauchi State:

• Establishment of SEMCHIC

• High level commitment and support from the traditional council on implementation of SEMCHIC interventions

• PHC facilities provided with Mama and delivery kits

• On the job training on Data Management and Infection control/hygiene

• WDC understands the need to include RMNCAH+N Issues in meeting agenda

• Development of SEMCHIC work plan Other State engagements were Bauchi, Taraba, Katsina

Dr Nwosu Presenting Mama Kits to Gov Taraba First Lady Bauchi State Decorated as NEMCHIC Ambassador


First Lady Katsina State Being Decorated as

Patroness Katsina NEMCHIC

Dr. Onwu Presenting Mama Kits to ES, Katsina

SPHCB

2.1 Figure 1


3.1.5 Nutrition

3.1.5.1 Accelerating Nutrition Results in Nigeria (ANRiN) Project

ANRiN is a Twenty-One-year (2019-2040) Federal Government Response facilitated by

NPHCDA at PHC level in a Phased Approach to Reduce Chronic Malnutrition (Stunting and

Micronutrient deficiencies) and thus reduce Maternal and Child Mortality Rates and, over

time, increase School completion and performance, and improve labour force Productivity.

The Project Objectivesare:

• To increase utilization of quality, Cost-effective Nutrition Services for Pregnant and

Lactating Women, Adolescent Girls and Children under five years in Abia, Akwa Ibom,

Gombe, Kaduna, Kano, Kogi, Kwara, Nasarawa, Niger, Oyo and Plateau States (Phase

1: 5-year duration; 2019-2023).

ANRiNwas designed to achieve a balance between the urgent need to protect Nigerian

Children from the devastating and life-long effects of stunting through the scale-up of cost-

effective interventions and strengthening the stewardship role of the Federal and State

governments in Nigeria to plan, finance, implement, monitor and learn from large-scale

nutrition programs through Disbursement Linked Indicators (DLIs) to incentivize delivery of

nutrition sensitive ante-natal care for Pregnant Women through Public Primary Health Care

Centers.

NPHCDA will be providing technical support to State Primary Health Care Boards (SPHCBs) on

the World Bank Mission towards Accelerating Nutrition Results in Nigeria.

DASHBOARD FOR SPHCB/NPHCDA ANRiN PROJECT

S/N Activity

Target

No of

Entity Achieved Gap Remarks

1

Development of

SPHCB/NPHCDA 2019 costed

work plan 12 12 0

All 11 SPHCDBs and

NPHCDA

2 No Objection of World Bank

12 12 0

All 11 SPHCDBs and

NPHCDA

3

Set up of dedicated project

account for ANRiN 12 12 0

All 11 SPHCDBs and

NPHCDA

4

Publishing of approved ANRiN

work plan on SPHCB/NPHCDA

Website 12 12 0

All 11 SPHCDBs and

NPHCDA


5

Operationalization of ANRiN

dedicated Project Account 12 11 1

Only NPHCDA is yet to

operationalize its ANRiN

Account

6

Roll out of project activities in

States 11 0 11 Pending


4.0 STRENGTHENED HEALTH

SYSTEM FOR DELIVERY OF

PACKAGE OF ESSENTIAL

HEALTH CARE SERVICES


4.1 Human Resources for Health

4.1.1 Staff Recruitment and Training Recruitment and Documentation of Programme and Operation officers: August, 2019

Enrolment of thirty (31) officers who will be retiring in 2020 into the PENCOM database: July-

August, 2019.

Update of the 2019 promotion on the IPPIS portal: August, 2019

• Orientation workshop for newly recruited officers: August, 2019

• Workshop on Efficient Service Delivery through Discipline in the work

• Training on Work Ethics and Attitudinal Change (GL 15 - 16) and Improving Personal Effectiveness (GL 13 - 14), March, 2019.

• 2019 Promotion exercise: June-July, 2019

• Orientation workshop for Corp members and IT students: July, 2019

• Entrepreneurship Development Training for officers that will retire in 2020.

4.1.2 Ongoing/Outstanding Activities for the Year:

• Staff Audit exercise.

• Capturing of newly recruited officers on the IPPIS portal.

• Staff Training

4.1.3 N-Power Health Initiative The N-Power Health Initiative (2 years programme) is one of the four pillars of N-Power

Volunteers Corps; a Social Investment Programme of the Federal Government of Nigeria

designed to address high unemployment rate in the Country for the population (18 and 35

years). The initiative also seeks to strengthen the entrepreneurial and technical skills of the

volunteers with view to enhancing their employability after the programme. Since

November 2016, about 50,000 volunteers for health to work in their various Local

Government Areas of residence have been concluded, engaged and deployed to States to

work in the Primary Health Care Space.

The key activities conducted includes the review and update of training materials for the

volunteers and sub-national planning meetings.

4.2 Health Infrastructure

4.2.1 Health Facility Assessment for the Southern States As part of PHC re-vitalization, the National Primary Health Care Development Agency

(NPHCDA) conducted a nationwide Health Facility assessment with the following Objectives:

• To Provide a Comprehensive Database and Directory of Primary Health Care (PHCs) facilities in Nigeria

• To Validate the Primary Health Care facilities and Update the National HF List

• To Assess the Functionality of the PHC facilities


• To Provide Evidence for Resource Mobilization and Distribution for Effective Service Delivery by the PHC System in Nigeria.

The assessment was conducted by the National Primary Health Care Development Agency

(NPHCDA) with technical support from eHealth Africa. Mobile data collection technique

using Open Data Kit (ODK) and Gather2 platform used for the exercise.

Southern States Assessment took place in the Second Quarter of 2019 while the Northern

States took place in 2018. The following five Domain Areas were Assessed:

• Infrastructure

• Ward Mechanism/Governance

• Staffing

• Health Commodity Supplies

• Basic Services

SUMMARY OF FINDINGS:

17 SOUTHERN STATE AS SHOWN BELOW

Table 11: Findings of Health Facility Assessment in the Southern States

S/N ZONE STATE NUMBER OF HF PLANNED NUMBER OF HF

ASSESED

FREQUENCY (%)

1 SOUTH EAST ABIA 687 661(96.22%)

2 SOUTH EAST ENUGU 514 538 (104%)

3 SOUTH EAST EBONYI 474 458 (95%)

4 SOUTH EAST IMO 531 529(99%)

5 SOUTH EAST ANAMBRA 289 323 (111%)

7 SOUTH SOUTH RIVERS 377 373(99%)

8 SOUTH SOUTH EDO 471 485(103%)

9 SOUTH SOUTH DELTA 419 384 (92%)

10 SOUTH SOUTH AKWA IBOM 451 455 (101%)

11 NORTH SOUTH BAYELSA 193 205 (106%)

12 SOUTH WEST EKITI 306 335 (109%)


13 SOUTH WEST ONDO 582 586 (100.69%)

14 SOUTH WEST OYO 759 766 (100.92%)

15 SOUTH WEST OGUN 508 505 (99%)

16 SOUTH WEST OSUN 870 829 (95%)

17 SOUTH WEST LAGOS 305 309 (101%)

4.2.2 2019 Conditional Assessment/Survey for Project under the 2018 Appropriation The Project Monitoring and Implementation Division carried out a Conditional Survey of all the

Health Facilities that were to be renovated from One to Six (6) Million Naira.

Staff of the Project Monitoring Implementation Division (PMID) were engaged in the exercise to be

able to conduct a Physical Assessment of the level of dilapidation of selected PHC facilities

appropriated in 2018 budget and produced a narrative report with the Bill of Quantity for each Site.

The Zonal Technical Officers (ZTOs) and the LGA officers were directly involved in these sites’

inspection along with the Staff from the Headquarters and State Offices – State Coordinators.

The Table below is a Summary of the Status of the Assessment Exercise

4.2.3 Health Facility Dashboard Following the Health facility Assessment, the division with the support of ehealth Africa developed a

health facility dashboard for the Agency, this is to enable a quick access to the status of all the PHCs

in the country that were assessed.

SN ZONE TOTAL NUMBER OF SITES NUMBER SUITABLE FOR RENOVATION

1 North-Central 10 10

2 North-East 3 3

3 North-West 7 7

4 South-East 16 16

5 South-South 9 9

6 South-West 11 11

TOTAL 56 56


The data of the assessment included Pictures of the facilities as submitted on the server by the

individuals was used for analysis, ranking and report for each State using data on the above domain

areas. Over 21,000 health facilities were captured on the dashboard showing the pictures and status

of each facility. This is still yet to be made accessible to the public because the data collected from

the Health Facility assessment is still being validated.

Figure 12: The Health Facility Dashboard

4.2.4 Renovation of HQ, Annex, Zonal and State Offices

• During the year under Review, Management of NPHCDA renovated, furnished and equipped with

State-of-the-Art Equipment her Offices at the HQ, Zones and States. The Offices are now having a

new look and comparable with Standards in other Sister organizations.

Comprehensive renovation of the Headquarter (August-December, 2019)/Annex (January-August,

2019)/State offices (September- December, 2019).

Furnishing of the Annex office (October-November, 2019).

Provision of 300KVA generator set for the Annex office (October-November, 2019).

Routine maintenance of the office facilities/furniture and equipment.


Figure 13: New NPHCDA Looks

New look of NPHCDA HQ at Gimbiya Street, Garki Abuja

4.2.5 Upgrade of NPHCDA Internet Facilities In order to deliver better internet experience to Staff and to prepare for deployment of fast-internet-

demanding solutions, the internet service provision contract was reviewed. Glo was selected as the

preferred Service Provider of STM-1 Capacity. This was fully deployed in March, 2019. Prior to

deployment, infrastructural updates were done on existing devices which included routers, switches,

antennas and access points. These are all functioning well. The ICT Unit also deployed an Enterprise

Internet Security: ESET Endpoint Security was approved at the close of 2018 for 500 users as a result

of the inventory of ICT equipment of Staff carried out by the ICT team. This was deployed to provide

protection to Agency Staff.

4.2.6 Other achievements:

• Distribution of 400 units of USB drives of varied Capacities (4GB: 200; 8GB: 100 & 16GB: 100). These were meant to be distributed to staff that responded to the online inventory form that was sent through the official email platform to encourage use of the official email. Distribution was concluded with the completion of the last set of Zonal Retreats.

• Deployment of fire suppression Systemin the Server Room to take care of any incidence of fire outbreak in the ICT Office. The System automatically quenches fire through a delicate Smoke Detection System and is Serviceable every Six Months. The first Servicing due Six Months Post-deployment has already been paid for.

• Installation and Configuration of Server Procured for NPHCDA by AFENETand ready for use and already functioning.

• Procurement and activation of Office 365 E3 License

• Deployment of Office 365 E3 P Solution has commenced and is still ongoing.

• Installation of Clock-in devices for two locations: Asokoro and Sahad Stores junction Offices. Configuration and installation would be completed.


• Security door, CCTV cameras and access control systems have already been deployed in the office to guarantee the integrity of information housed in the server.

Challenges:

• Inadequate Personnel The ICT Unit, with the quantum of responsibilities being taken up and solutions proposed currently lacks the requisite personnel. This is slowing down the deployment of available solutions and the response time to issues, particularlytroubleshooting. The Unit is in dire need of personnel with competencies in database/software management, hardware management, network administration etc.

• Office Space Sequel to the enlargement of the server room, the remaining space in the ICT Office can no longer accommodate the staff, including NYSC and IT personnel attached to the Unit. The proposed movement of critical databases from Partners to the NPHCDA server would also mean that access to the server room must be restricted.

4.3 Medicines, Vaccines and Other Health Technologies and Supplies

4.3.1 State Engagements and 2020 Vaccines States Specific Forecast. The Department of Logistics and Health Commodities (LHC) Conducted the Second States

Specific Vaccine Forecasting in 2019 based on the result of 2018 NDHS.

The Objectives of the exercise were as follows:

• To Review the Current 2019 Forecast and its Performance for the States

• Conduct the Forecast considering the new trend of coverage per vaccine antigens

• Review consumption on coverage data for preceding year to guide the forecast assumptions

• Determine target and activities for the coming year including new vaccine introduction campaigns and expected coverage projections

• Forecast quantities for the year 2020 using the just concluded nationwide physical stock count of immunization supplies

• Prepare a shipment plan for vaccine and devices based on our storage capacity

Summary of Findings

Following the Physical Count exercise across the Country, the following findings were made:


Quantitative Findings:

• Huge disparity in quantities of vaccines and diluents e.g high volumes of vaccines in VVM Stage II

• Sustained disparity in quantities of vaccines and diluents for BCG, Measles and Yellow Fever vaccines

• High volumes of bOPV and Pentavalent vaccines in VVM Stage II

• High volumes of nearly expiring vaccines

• PCV2 is still in circulation

• Overstock of some vaccines, including bOPV and Pentavalent vaccines, at a number of LGA stores

• Stock-on-hand is disproportional to target population of the LGA cold store

Qualitative Findings:

• Non-recording of stock transactions related to vaccine diluents and injection devices in the Vaccines/Diluents/Injection Equipment ledger across all levels

• Limited/no reporting of vaccines/diluents damage and expiry across all levels

• Disparity between physical stock count, ledger entries and LMIS’ at appropriate levels

• Multiplicity of data tools that are not in compliance with nationally approved data tools

Communique Issued at the States-Specific Vaccines Forecasting For 2020 Held at Barcelona

Hotels, Blantyre Crescent Wuse 2, Abuja

The following Recommendations/Resolutions were adopted:

• Physical Stock Count should be conducted monthly at State level and Weekly at LGA and Facility levels by the cold chain officers at all levels with regular effective Supportive Supervision by the SLWG

• The National Logistics Working Group (NLWG) to agree on more reliable denominator to be used by states for vaccine forecasting

• High doses containing vaccines like BCG should be reduced by the manufacturers, immunization sessions and SIAs properly monitored, improve the capacity of vaccine stakeholders across all levels and revamp cold chain infrastructures

• States should provide budget line and release funds timely for vaccine logistics to all levels in the State

• Establish/Reactivate SLWG, provide budget line to fund the LWG and monitor the implementation of Continuous Improvement Plan (CIP)

• National and States to provide data tools, States to improve capacity of stakeholders on DHIS2 usage by training and retraining and National to improve the functionality of the DHIS2 platform by allowing the State to have full access and control facilities on the platform


4.3.2 Vaccine and Related Commodities Physical Stock Count in Nigeria from 10th – 23rd June, 2019 As part of the drive to improve Vaccine Accountability and Stock Management, the NPHCDA

through the National Logistics Working Group (NLWG) conducted a nationwide Physical

Stock Count (PSC) Exercise from the National level to the Service delivery points. The

Purpose of this exercise was to provide Strategic and actionable insight into the volume of

Vaccines and related Commodities available ahead of the 2020 Vaccines and devices forecast

exercise.

The Objectives were:

• To Conduct a Physical Stock Count of all Antigens and devices at the National, Zonal, State and Local Government Area (LGA) Cold and Dry Stores, Health Facilities (HFs) with Cold Chain Equipment and other Storage points across the Country;

• To determine the actual quantity of Vaccines and related Commodities in Country

• To verify the accuracy and completeness of stock records at all levels in compliance with best practices

• To obtain selected indicators that provide insight into performance of Nigerian iSC and its alignment with the Dashboard for Immunisation Supply Chain (DISC) indicators

• To support stores to arrange products according to Earliest Expiry FirstOut (EEFO) principle

• To identify gaps and recommend strategies for improving stock and inventory management practices per EVM Standards.

FINDINGS

The following were some of the findings from the various Zones and their corresponding

States, LGAs and HFs.

SOUTH WEST ZONE FINDINGS

• Results of the PSC at the SW Zonal Store revealed that all the assessed vaccines and diluents were available in the store. The most stocked vaccines and devices were bivalent oral polio vaccine (bOPV) and 0.5ml syringe respectively while the least stocked vaccine and devices were Yellow fever vaccine and 2ml syringe respectively.

• PSC results from the Six SW State stores revealed that the most stocked vaccines were monovalent oral polio vaccine type 2 (mOPV2) with the highest stock found in Lagos State store, Yellow fever with the highest stock found in Ondo State store, and bOPV with the highest stock found in Lagos State store.


Meningococcal ACWY vaccine (MenACWY) was found only in Lagos State store, Inactivated polio vaccine - 10 (IPV10) was only found in Ekiti and Ogun State stores while Pneumococcal conjugate vaccine – 2 (PCV2) vaccine was found only in Ekiti State store.

• Across all the stores visited, the most stocked device was 0.5ml syringe while the least stocked was 2ml syringe. Also, there was no expired vaccine at the zonal and State stores, but expired devices were found only at the zonal and Lagos State stores. However, ‘soon-to expire’ vaccines were found at the zonal and State stores.

• It is worthy of note that there was no Trivalent oral polio vaccine (tOPV) vaccine found in any of the stores visited in the SW zone. However, mOPV2 vaccines were found, at all the levels of the supply chain.

• All WICRs in the State stores were functional. However, in Lagos State Store, one of the compartments of the dual WICR was not functional. Further analysis showed that about 83% of the deep freezers in Lagos State Store and 47% of deep freezers in Ekiti were functional. Additionally, no deep freezer was reportedly found in Ogun and Ondo State cold stores.

• SOUTH EAST ZONE FINDINGS

Total stock of vaccines, diluents, devices, data tools and asset – including diluents (in vials

and doses) segregated by batch number, expiry date and VVM status.

The Tables below showed the sums of the Vaccines counted at each Zonal, State and LGA

Cold Stores.


Pivot Tables for Vaccines and Diluents

Zonal Cold Store

The physical count exercise at the South East Zonal stores (cold and dry) reported all

vaccines on the routine immunization list as been currently available. The most stocked

vaccines at this store were bOPV (6,406,280 doses) and Penta (1,348,110 doses), and the

most stocked diluent is BCG Diluent at 624,120 doses.

Review of the store’s LMIS (NISCMIS) revealed it stocked out of two vaccines (BCG and

Yellow Fever) for a period of 17 days.

The following are initial observations and/or challenges identified from the data presented in

the pivot table of stock:

• Critical for the zonal cold store is the volume bOPV meant for SIA in VVM stage II. The following are recommendations for addressing this;

• During the SIA for which the bOPV will be used, emphasis must be placed on maintaining the integrity of cold chain (using appropriately conditioned ice-packs during transport and campaign trips etc.).

• In the mean-time care must be taken to ensure the cold storage for bOPV is not compromised.


• There are 33,150 doses of IPV10 in stage II. The Storage, handling, transport of these must be monitored carefully to avoid the administration of IPV in VVM stage III.

• The NPHCDA should consider redirecting some of the bOPV in the SEZ Cold Store to other locations that may have more urgent SIA needs.

• In general, the vaccine in VVM stage II should be prioritized for use above those in stage I.

• There is a significant mismatch in the volume of freeze-dried vaccines and their diluents reported. With one exception, diluents reported are more than the vaccines in store.

• This is likely due to retaining diluents after vaccines have been discarded due to expiry or change in VVM status. It is important to lay emphasis on diluents that are batched/bundled with their vaccines and when vaccines are retrieved and discarded, the associated diluents should also be returned to the national store.

• Overages and shortfall in the mismatch between vaccines and diluents should be addressed within the zone by redistribution across the state cold stores to address current mismatches at that level. In the instance of yellow fever, more diluents need to be supplied to the zonal store address the shortfall.

All the Cold Chain Equipment at the Zonal Store were functional and well maintained.

However, both air conditioners at the zonal store are not functional due to damage as a

result of electrical surge when connected to the national grid.


The South East Zonal Cold Store tracksStock of RI Commodities using GON ledgers and a

logistics Management Information System (NISCMIS). Review of both data collection tool

for stock balance following completion of the PSC revealed differences between the store’s

own data tracking tools.

There were significant differences (> 2%) the ledger stock balance and that in the LMIS in 5 of

the 9 vaccine stock balances compared in the table above. The LMIS is the primary stock

tracking tool at the store, it is apparent there are significant flaws in the data management

flow at the zonal store.

The stock balance following the completion of the PSC only had two exact matches with

zonal store LMIS stock balance, PCV 4 and Td.

Similar to the zonal store, four of the five state stores in the zone use both GON ledgers and

LMIS for data management (Imo State Cold Store has not been equipped for LMIS).

However, the PSC team did not have access to the LMIS data for Anambra State Store

during the exercise as there was a technical issue with the system according to the CCO. The

LMIS in Abia State is functional but read zero for all stock balances.

Out of the two state stores with available stock balances for both the ledger and LMIS, only

Enugu State store had an 100% match in its record for the five selected tracer vaccines in the

table above. The PSC count for three of the vaccines (BCG, bOPV and Penta) was also an

exact match with records on the ledger and LMIS. Ebonyi State Cold Store also had an exact

match between the PSC balance, the ledger and LMIS for two vaccines.


SOUTH SOUTH ZONE FINDINGS

Vaccines and Diluents

The results of the Zonal Cold Store audit are presented in the tables below:

Quantity of Vaccines and Diluents located in the South South Zonal Cold Store, Warri.

Vaccines and Diluent Quantity (Doses)

BCG 281,860

Measles 385,750

YF 831,830

bOPV 7,034,000

HepB 289,530

IPV10 168,670

Penta 790,130

Td 241,240

BCG Diluent 284,460

Measles Diluent 2,520,280

Yellow Fever Diluent 1,300,470

The results from Table above showed that bOPV, Yellow Fever and Penta vaccines are in

higher supply compared to Measles, Hepatitis B or Tetanus vaccines. In terms of diluents,

Measles and Yellow Fever diluents dominate in terms of availability in the Zone. However,

there is an uneven ratio of lyophilized Measles and Yellow Fever vaccines to their respective

diluents. In both cases, the diluents out-number the vaccines by a large margin.


Devices

Quantity of Devices located in the Zonal Cold Store.

Devices Quantity (Pieces)

AD BCG Syringes

(0.05ml)

1,000,300

AD Syringes (0.5ml) 10,205,300

RECON2M 39,000

RECON5M 645,390

Safety Boxes 195,842

In terms of devices found in the dry store, the AD syringes had the highest stock balance of

over ten million pieces, as seen in Table above.

NORTH EAST ZONE FINDINGS

The findings in the zonal cold store reveals that the quantity in doses for BCG vaccine and its

corresponding diluent used for RI is 60,620 and 8,140 doses respectively. A total number of

9,765,220 doses of bOPV in VVM stage I was used for both RI and SIA. Measles and Yellow

fever vaccine and their corresponding diluents were seen to have a total number of 308,710

and 422,310 and 229,520 and 306,990 respectively. From the findings, it is shown that a total

quantity of 720 doses of bOPV in VVM I stage to be used for SIA at the North East Zonal Cold

Store, have a close expiration date December 2019, 01-12-2019 and also the findings shows

that a total quantity of 200 pieces of AD BCG Syringes (0.05ml) have a close expiration of

December 2019, 01-12-2019 at the North East Zonal Cold Store. A total number of 2,111,981

devices were counted at North East Zonal Cold Store, with the AD Syringes (0.5ml) having

the highest number of quantities in pieces, a total sum of 1,263,900 pieces, followed by the

AD BCG Syringes (0.05ml) with a total sum of 448,350 pieces and safety boxes having the

least quantity, with a total sum of 2,235 pieces.

In Adamawa state has a total number of 167,960 doses of bOPV vaccines are in VVM stage II

for RI activities. We also have 13,120 doses of Penta in VVM stage II as well. 31,952 pieces of

AD BCG Syringes (0.05ml), 74,000 pieces of AD Syringes (0.5ml) were also found.

Across the states in the North Eastern State Cold Stores, a total number of 255,040 doses of

BCG were counted with corresponding 180,180 doses of BCG diluent. A total of 2,272,100

doses of bOPV were counted with over 1,017,680 of these already in VVM stage II. A total of


380,660 doses of mOPV2 were also found. From findings, Bauchi State has a total number of

824,720 doses of bOPV vaccines which are in VVM stage II cutting across both RI and SIA

activities. Borno state has a total of 480,000 doses of bOPV vaccine and a total number of

6,530 PCV4 vaccines which are VVM Stage II. Gombe state has a total number of 25,000

doses of bOPV in stage II, 17,100 doses of IPV10 in stage II and 61,410 doses of Penta in stage

II. From the finding, more BCG vaccines can be found in the Taraba state cold store without

the matching number of diluents. The State also has a total of 315,120 doses of bOPV. Yobe

state has a total number of 5,200 doses of IPV5 in VVM stage II. During the stock count

exercise, 33,100 doses of bOPV were counted. No tOPV was found in the North East Zone.

From the findings, it was shown that in Adamawa state, Gombi LGA Cold store and Song LGA

Cold store had IPV10 and Penta vaccines in VVM stage III. Also, Hong LGA Cold store was

seen to have 220 doses of bOPV in VVM stage IV. Additionally, in Michika LGA cold store of

Adamawa state, Hep B vaccine used for RI programme expired on the 1st of April 2019 and in

Damaturu Satellite Cold Store, Yobe state, mOPV2 was seen to have expired on 01/09/2018.

Findings also shows the vaccine/diluent that had expired in the Zonal cold store. Measles

diluent of batch number 9912414 and 03-1674 expired in 01/05/2019 and 01/08/2018

respectively. Furthermore, Yellow fever diluent with batch number 46 and M8003-1 was

found to have expired on 01/04/2019 and 01/01/2018 respectively. Td was also seen to have

expired on 01/01/2018.

Across State cold stores in the North East Zone, findings showed that there were less than

1% (<1%) closed vial wastage of vaccine and diluents.

At the North East Zonal Cold Store level, most of the storage points had full stock availability

of over 80% for the resupply period. Analysis of findings from the physical stock count also

revealed that at the state cold store level, 94.9% of the state cold stores had full stock

availability over the resupply period. In the North East zone three states (Bauchi, Borno,

Yobe) have state satellite cold store. The state satellite cold store supplies stock to the LGA

cold store. Very few states satellite cold stores experienced stock out over the specified

resupply period. 94.7% of the satellite cold store had full stock availability. Findings also

showed that 89.40% of the LGA cold store across the North East zone had full stock

availability of vaccines and devices across. At the Health Facility Level, Majority 92.7% of

health facilities had full stock availability over the specified however, only 5.9% of the health

facilities in the North East Zone experienced stock out of vaccines and devices over the

specified resupply period.

Significant non-functional cold chain equipment as shown in the table 48 include 2 walk-in

cold room in Taraba and 1 walk in freezer also in Taraba. All walk-in cold rooms at the North


East State Satellite cold stores are functional. There was however a single unit of Ice pack

Freezer found at the Borno Central State Satellite cold store which was non-functional.

In calculation of the DISC indicator stocked according to plan (SATP) requests over a

specified period were used to calculate the average monthly consumption (AMC) and the

stock on hand which was obtained during the physical stock count exercise was then used

to calculate the months or weeks of stock. The estimates from Bauchi, Adamawa, and Yobe

state cold stores show that these stores are understocked while the Borno state cold store

is overstocked.

Compliance with best storage and record keeping practices seemed to decline significantly

down the supply chain as it was observed that the LGA separated and documented expiries

better than the health facilities. Comparison across the states showed that Gombe state

health facilities had a poor compliance to best storage and record keeping practices. 14% and

10% of the health facility in Bauchi and Adamawa were seen to document damages and

expiries following best storage and record keeping practices. More than 60% of the LGA cold

stores across the 6 north eastern states observe EEFO principle and store vaccine under the

right temperature. LGA cold stores especially in Bauchi and Borno did not seem to have

shelves and pallets to properly store their dry stock items. Separation and documentation of

expiries seemed to be a common challenge at the health facilities and LGA cold stores. All

the state cold stores in the NEZ including the zonal cold store observe the EEFO principle in

vaccine/diluent and devices storage except the Borno state. Shelves and pallets can be

found in the dry store of the NEZCS and that of the six states cold stores in the zone. All the

state cold stores seem to separate expiries from the usable products. Finding also shows

that these expiries are documented and properly recorded into a designated checklist.

Data Accuracy was determined using the WHO’s validated standard methodology for

immunisation Data Quality Audit (DQA). This methodology was adopted to compare stock

balances across physical count quantity, ledger balance and LMIS balance at the Zonal, State

and Health Facility Cold Stores. An Accuracy Ratio of between ≥ 0.95 to ≤ 1.05 indicates

consistent data and AR of < 0.95 or >1.05 indicates data over reported or under reported.

The figure below shows that some satellite stores still have challenges with data accuracy

and records are not transferred adequately into the ledgers and the LMIS system available.

At the State level similar documentation challenges exist across board except in Bauchi state

where adequate records are kept and transferred across the physical count conducted,

ledgers and LMIS available.


NORTH CENTRAL FINDINGS

Vaccines and diluents were taken stock of and recorded at the National Strategic Cold Chain

Store. All vaccines and diluents counted were in the VVM stage I and were used for both

Routine Immunization and Supplementary Immunization activities. The quantity in doses for

BCG vaccine and its corresponding diluent used for RI is 2,358,480 and 2,451,140 doses

respectively. The total number of bOPV is 12,222,760 doses as seen in the table shown above.

Measles vaccine and its corresponding diluents used for RI have a total number of 4,937,040

and 3,576,900 while Yellow fever vaccine and its diluent was seen to have 2,732,360 and

4,824,460 quantities in doses respectively. At the National Strategic Cold Chain Store AD

BCG Syringes (0.05ml) and AD Syringes (0.5ml) have a total number of 4,167,660 and

1,045,953 pieces respectively. The 2ml and 5ml RUP Reconstitution Syringes were 3,592 and

665,558 pieces respectively. 5L safety boxes were 34,106 pieces in quantity.

The North Central Zonal Cold store, the team found disparities between BCG vaccine and its

corresponding diluent at 2,284,480 and 631,020 doses respectively as well as Measles

vaccine and its diluent with a total number of 252,660 and 343,100 doses respectively. The

table above also shows that Yellow Fever vaccine and its diluents are 151,300 and 206,550

doses respectively. 1,565,600 doses of bOPV were found to be in VVM II. Other vaccines

counted include IPV 10, Penta and Td with 346,000, 352,360 and 188,660 doses respectively.

A total of 992,990 pieces AD Syringes (0.5ml), 45,730 pieces of AD Syringes (5ml) and

143,225 pieces of Safety boxes (5L) were counted in the zonal cold store.

At the National and North Central Zonal Cold Store there were no historical expired and

damage vaccines found over the specified period. Across facilities and cold store in the

North Central Zone, findings showed that there were less than 1% (<1%) closed vial wastage

of vaccine and diluents. With exception of Kwara State where Penta vaccine was found to

have 4.96% Closed Vial wastage rate.

At the National and Zonal Cold Store level, no stock out was recorded, as they both had a

100% full stock availability over the resupply period. Analysis of findings from the physical

stock count also revealed that at the state cold store level, 87.50% of the state cold store had

full stock availability over the resupply period. Findings also showed that at the Local

Government Area Cold Store level, 92.50% of the LGA cold store across the North Central

zone had full stock availability of vaccines and devices over the resupply across. At the

Health Facility Level, Majority 93.6% of health facilities had full stock availability over the

specified period.

A further analysis was done at the state level and findings showed that health facilities and

cold store in Kwara State did not have any stock out of vaccines and diluents within the


period of review (100% full stock availability). However, facilities and Cold stores in Niger and

Nasarawa State, had the lowest (85.1% and 85.3% respectively) full stock availability when

compared to other states in the zone.

A DISC indicator (functional Status of cold chain equipment) was determined in combination

with other cold chain assets by estimating the ratio between the quantities of functional and

non-functional items. Vaccine carriers, walk in cold rooms and freezers were 100% functional

at the National Strategic Cold Store. The Store had just one non-functional domestic freezer.

The walk-in freezer room, refrigerator rooms and cold boxes were 100% functional at the

NCZCS.

NORTH WEST ZONE FINDINGS

Analysis of the Proportions of Vaccines/Diluents at the Facilities Level

The chart below depicts the proportion of all vaccines and their corresponding diluents at

each supply chain level in all the seven (7) states. 32.9% BCG was at the zonal cold store. Also

at the zonal store, was bOPV at 87.0%, mOPV at 86.4%, and PCV4 at 44.1%, Penta at 48.3%, Td

at 50.5% and YF at 55.7%.

In addition, them OPV2 was mostly available at the zonal cold store (86.4%) as it is only been

used on an outbreak basis.

Antigens like IPV10 (83.6%), Men ACW (92.3%), Men A Diluent (96.8%), and PCV (49.0%) were

mostly found in the state cold stores pending distribution to the satellite, LGA and health

care facilities.

Proportion of vaccines/diluents at the facilities levels


Analysis of Vaccines/Diluents Expiry in the North-West Zone

The chart below shows the total doses of all vaccines expiring in July 2019 up to December

2020. There are relatively large number of vaccines that will be expiring in 2019 like the Penta

with 1,176,922 doses, Measles 68,320 doses, Hep B 1810 doses, and Yellow Fever 7270 doses.

While, most of the vaccines, will expire in 2020 like the BCG with 1,258,377, bOPV 16,160,296,

Men A 14, IPV 3660, and PCV with 220 doses.

Analysis of vaccines/diluents expiry

The table below shows the total number of vaccines at each supply chain level and their year

of expiry for 2019, 2020 and 2021 and above.

While twenty million, one hundred and six thousand, three hundred and fifty-eight

(20,106,358) doses of vaccines will be expiring by 2020, six million, nine hundred and sixty-

one thousand, five hundred and seven (6,961,507) will expire 2021 and above.

By the end of 2019, one million, two hundred and eighty-six thousand, six hundred and four

(1,286,604) doses of vaccines would have expired.


Ageing of the number of doses of expiring vaccines in the North-West Zone

RECOMMENDATIONS

SOUTH EAST ZONE RECOMMENDATIONS

Zonal Cold Store

1. The Air Conditioners are non-functional and will put pressure on the WICR/Fs.

a. Fix Air Conditioners to optimize/increase efficiency of WICR/Fs and maximize lifespan.

b. Capacity building for store, cold chain and stock management should continue to be built

to ensure the zonal store adheres to best practices.

State Cold Stores

1. Cold Stores should be air-conditioned. Only Anambra CS is air conditioned. A hot and/or

humid interior reduces the efficiency of the CCE unit stored in it.

2. The State stores seem to have sufficient storage space. Repairing the non-functional Ice-

lined Refrigerators and WICRs will vastly increase available storage space for the short–term

and foreseeable future.

3. The Ebonyi State Cold Store has significant challenges with electricity and off-the-grid

solutions should be considered.

4. Training and capacity building to ensure appropriate management of the CCE assets and

the stock is needed across staff at the state stores.

5. A significant number of the state stores require infrastructural upgrades that are essential

to the security of the vaccine and CCE stored in them.

LGA Cold Stores


1. Dry Stores should be equipped with shelves and pallets to enable efficient storage of the

dry goods.

2. LGA cold Stores should be air-conditioned to extend the lifespan on the Ice-lined

refrigerators and increase the efficiency of the storage devices kept there.

3. Stores should be encouraged to institute the Early Expiry, First Out (EEFO) stock

management principle.

4. A significant proportion of CCE at the LGA and State stores are non-functional, with

number of LGA stores having to store their vaccines at nearby facilities. Nearly half of the

CCE in Abia are non-functional. States need to develop a Preventive Maintenance Plan to

routinely service functional CCE as well as identify and fix non-functional yet repairable ones

within a reasonable time. This should be preceded by an obsolescence analysis to identify

CCE that should be discarded – using environmentally responsible and safe techniques -and

not counted as part of the state cold chain asset. Obsolescence analysis (and performance

testing) also needs to be conducted for passive devices to ensure they are still viable and

functional.

5. A significant number of the state stores require infrastructural upgrades that are essential

to the security of the vaccine and CCE stored in them.

Additional LGAs without storage capacity

1. Oguta local government area cold store, in Imo State, stored their vaccines at Egbeoma

health center.

2. 500 doses of expired vaccines (Penta) were retrieved during counting at Egbeoma health

center

3. One functional freezer belonging to Oguta local government Area is at Imo state Cold

store.

4. Owerri West LGA stock their vaccines at Obinze health centre

General

The NPHCDA should pursue certain best practices to achieve the required safety standards

1. Air conditioning rooms/stores that house CCE significantly improves their efficiency and

this should be pursued as a best Practice.


2. Providing a reliable power source for State/LGA cold stores (a sustainable mix between

national grid access and a supplementary power generation equipment).

3. Capacity building on skills on the organization of stores - dry or cold – (EEFO, the use of

pallets and shelves, etc.) is critical to appropriate record keeping and proper management of

stock and assets.

4. Activity should not be conducted during the rainy season as it was difficult to access some

areas it also increased the hours spent on the road consequently increased the number of

days for completion of the exercise.

SOUTH WEST ZONE RECOMMENDATIONS

The 2019 PSC presents comprehensive findings on the total physical stock of all vaccines,

diluents and devices available at the SWZ cold store, six State stores (Ekiti, Lagos, Ogun,

Ondo, Osun and Oyo State), all LGA stores and all HFs with cold chain equipment, with key

indicators that provide insight into the performance of the supply chain across the SW zone.

It is worthy of note that all the stores across all levels of the supply chain have a system to

run the store. This however should be in full compliance with the effective vaccine

management (EVM) standard at every level of the supply chain. This audit has provided

strategic and actionable insight into the volume of vaccines and related commodities

available insomuch as to guide the NLWG in the 2020 vaccines and devices forecast exercise.

Based on the presented survey findings, some recommendations are: (a) use of electronic

data tools for record keeping at the lower supply levels; (b) development of vaccines and

diluents redistribution protocol; (c) deployment of technically sound store keepers; (d)

continuous professional training of the stores technical officers so as to catch up with the

industry global best practice. Others are: (i) incentivizing best practices in EVM standards at

every level of the supply chain system; (ii) investment in store structures and equipment; (iii)

monitoring of performance of stores and supportive supervision; (iv) effective waste

management practice of cold chain waste; (v) questions on EVM compliance should be part

of subsequent PSC paper checklist; and (vi) vendor’s data manager should be granted access

to the server, alternatively, ODK input file should be shared with the vendors.

SOUTH SOUTH ZONE RECOMMENDATIONS

Vaccine to Diluent Ratio

▪ The Zonal Cold Store should distribute more Yellow Fever diluents from its large stock

(see Table 4.1), to stores or facilities lacking this commodity. This will also help to utilize

vaccines and devices which are close to expiry.


Staffing

▪ The Zonal Cold Store and Some State Cold Stores appear to be understaffed. While there

may be sufficient security guards in these facilities, it is recommended that more staff

trained in vaccine management are required to carryout the essential duties of the Zonal and

State Vaccine Cold Stores.

Record Keeping

▪ The data provided in this report should be used to assist Cold Chain Officers (CCO) to

update their stock records.

▪ Optimize the use of the web-based stock recording tool. The maintenance of accurate

stock records is critical for effective management of the stock. The use of the web-based

LMIS tool should be effected at all levels of the supply chain. It is also recommended that

the users of the LMIS be well trained vis a vis their roles.

▪ In order to maintain the drive for accurate and updated records at various supply chain

levels, the Physical Stock Count exercise should be conducted annually.

▪ Also, routine supportive supervision systems should be strengthened to ensure

continued reporting of stock levels by CCOs.

EEFO Compliance

▪ The vaccine stores at Zonal, State and LGA levels should ensure strict compliance with

EEFO principles. Store managers should ensure that all the stock movements are recorded in

the stock record tool (LMIS).

NORTH CENTRAL ZONE RECOMMENDATIONS

1. Identify and redistribute excess stock of vaccines at all levels of the supply chain.

2. Improve on stock distribution and transportation systems.

3. Ensure stock availability at all levels of the supply chain

4. Ensure continuous performance improvement on Effective Vaccine Management

Practices.

5. Separate and properly document of all damaged and expired stock.

6. Invest in store infrastructure like pallets, shelves, lighting, heat and ventilation equipment.


7. Continue Routine Monitoring and Evaluation of the vaccine supply chain system.

NORTH EAST ZONE RECOMMENDATIONS

1. Identify and redistribute excess stock of vaccines at all levels of the supply chain.

2. Improve on stock distribution and transportation systems.

3. Ensure stock availability at all levels of the supply chain

4. Ensure continuous performance improvement on Effective Vaccine Management

Practices.

5. Separate and properly document of all damaged and expired stock.

6. Invest in store infrastructure like pallets, shelves, lighting, heat and ventilation equipment.

7. Continue Routine Monitoring and Evaluation of the vaccine supply chain system.

NORTH WEST ZONE RECOMMENDATIONS

Poorly arranged stores

OIC should ensure that stores are properly arranged. All Inventory item arrangement should

be based on EEFO principle. Further to this, vaccine and diluents should be stored according

to the following:

• Vaccine type

• Vaccine manufacturer

• Vaccine Vial Monitor (VVM) stage

• Date of expiry Where the VVM stage of the vaccine has progressed, the OIC should be knowledgeable

enough to make an exception.

Facilities with near-expiry stock should liaise with the LGA or State Store to initiate the

process of having the affected stock moved to other facilities that may be in need.

A demarcated area marked “PRODUCTS FOR DISPOSAL” should be designated for holding

expired stock before proper disposal.

There should be an increase in the interaction between lower cadre staff and senior staff to

improve supervision, knowledge transfer, coaching, and training. Particularly, lower cadre

staff should be sensitized on the benefits of the EEFO principle of stock management.

Inadequate/no inventory record keeping


• All inventory records should be updated immediately.

• Periodic stock count of inventory should be initiated across all facilities. This stock count should be observed by the staff of a superior store. For instance, a LGA staff should observe the stock count of a primary health care facility.

• Facilities that accommodate the inventory of other facilities should maintain records of the inventory. Furthermore, the inventory should be segregated from that of the host-facility.

• Adequate inventory record can be considered as control responsibilities that could form part of the performance appraisal of the OIC.

• Also, vaccines for campaigns should be recorded separately from vaccines used in routine immunization. Combining records can give a false representation of stock levels.

Poor controls over inventory levels

The facilities should define their stock level including, maximum, minimum and re-order

levels. The stock level can be determined using the facilities’ daily/weekly stock consumption

rate as the basis for definition.

The OIC should regularly review stock levels to ensure compliance.

Poor physical controls over inventory

• The timely renovation of the affected facilities should be initiated to prevent exposure of the inventory to the elements and to protect the facilities’ buildings.

• The dry stores should be relocated from open spaces to secure places in the facilities. The facilities that are experiencing space constraints should consider relocating their open/unsecured dry stores to the OIC offices.


Permanent Secretary FMoH, Executive Secretary NPHCDA and Partners at Scenes of Launching Cold

Chain Equipment in ALEYITA PHC, Lugbe FCT Abuja.

4.3 Research for Health

4.3.1 Post Campaign Coverage Surveys (PCCS) Sequel to the Various Campaigns Conducted in 2019 on Yellow Fever, Measles, Meningitis, a PCCS

was Conducted to ascertain the Coverages, Card Retention of all antigens used. The Survey is still on

and Results are expected in early 2020.


4.3.2 Preston Leadership Associates Survey A Research Study was conducted by a Partner, Preston Leadership Associates on Leadership

Strategies for PHC Delivery Effectiveness in Nigeria to Achieve its Service Delivery Objectives over

the last three Years. The Research was conducted in all the Zones, EOCs in Bauchi and Kano and

some ZTOs were interviewed. The Research still On-going and will be conducted at the HQ, NEOC,

some of the Directors at HQ, Programme Managers/ Programme Officers. The aim of the Research

was to find out the Impact of the Innovative Interventions of the Agency over the last three years.

The Research is still on-going and the Results will be ready in the First Quarter of 2020.

4.3.3 International Standard Book Number (ISBN) Workshop The NPHCDA, in order to be on the same page with Global best practices, tthrough the Library Unit

conducted a training of Staff on ISBN with the mandate of giving ISBN numbers to all NPHCDA

Publications (both old and new).

4.3.4 Health Management Information Systems Several trainings and workshop took in the year under Review and notable amongst them included:

4.3.4.1 DHIS 2 DHIS 2 Training and Refresher with Support of AFENET N-STOP

All States have now graduated and migrated to DHIS 2 Platform for RI Reporting

Figure 14: Map showing States that have Graduated to the DHIS2 Platform

Map Showing the States that have Graduated on the DHIS2 Platform (State now take full

ownership)



Advocacy and Communication during Final Transition Visits

4.3.4.2 Data Quality Use Supportive Supervision) DQUSS

Conducted DQUSS in Delta July and Anambra States in August the last week of July to improve

the data quality, provide on the job mentoring and review RI data quality job aids and DQUSS

checklist. This exercise was also supported by AFENET-STOP in collaboration with FMOH.

On the job mentoring During Supportive Supervision (DQUSS and ISS)

4.3.4.3 Supportive Supervision

Conduct of Integrated Supportive Supervision in Bauchi, Kano, Sokoto, Anambra, Kwara,

Ogun and Ebonyi States between July and August, 2019 in collaboration with FMoH and MSH-

RSSH GF.


4.3.4.4 Monthly RI Feedback

RI Monthly Feedback has now been institutionalized and feedbacks given monthly.

4.3.5 Health Informatics Conference (HELINA Conference) in Botswana. In the last week of November, Staff from the M & E Division attended the HELINA

Conference for Health Informatics in Botswana.

Specific objectives of the conference were included:

• Instil a culture of digital health interventions that will generate data from evidence to

practice

• Build a data ecosystem in Africa for data health expert

• Outline strategies to institutionalize data health in respective countries to ensure efficient

health care delivery

Four posters were submitted by the CDC/NSTOP/NPHCDA GEEKS project and the GEEKS

fellows for each poster provided further explanations in the various sub project topics to

participants during the conference. A key outcome from the conference was the emphasis

on development of a public health informatics workforce through capacity building within

the continent. The established education working group within HELINA promised to bridge

this gap and collaborate with institutions in setting up public health informatics curriculum.

The next country to host the conference will be selected through a bidding process and

interested countries were encouraged to participate in the process. The HELINA board will

continue to engage participants via emails post conference and strengthen collaboration

with agencies e.g Africa CDC.


At the HELINA Conference Communique


5.0 PREDICTABLE

FINANCING AND RISK

PROTECTION


5.1 Health Financing

5.1.1 The Basic Health Care Provision Fund (BHCPF) BHCPF was established under Section 11 of the National Health Act (NH Act), as a key

principal funding mechanism towards achieving Universal Health Coverage (UHC) in Nigeria.

The fund is designed to provide additional funding to the health sector through three

gateways (National Health Insurance Scheme (NHIS), National Primary Health Care

Development Agency (NPHCDA) and Emergency Medical Treatment (EMT)).

The NPHCDA BHCPF Program Implementation Unit (PIU) was set-up in the NPHCDA to

effectively manage, coordinate and implement the NPHCDA gateway in realization of the

importance of the program towards the attainment of Agency’s goals and achieving

Universal Health Coverage.

In 2019, the team responded to all directives from the Management of the Agency, National

Steering Committee resolutions and played visible roles in the management and roll out of

BHCPF. There is a significant progress in the implementation of the BHCPF with

commencement of major activities such as baseline assessment, capacity building and

disbursement of fund to State Primary Health Care Board by the NPHCDA Gateway,

disbursement of fund to the benefiting & eligible PHC facilities from the State Primary

Health Care Board in three (3) States (Abia, Ebonyi, Osun) and FCT.

In line with the Agency Strategic Plan and approved workplan, the PIU carried out the

following activities in 2019 to ensure smooth take-off and effective implementation of

BHCPF as well as quality PHC service delivery in Nigeria:

5.1.1.1 Flag off of the BHCPF by HMH in Osun, Niger and Abia State

The BHCPF achieved another milestone as the HMH launched the enrolment of beneficiaries

and actual take-off of the BHCPF in Osun, Niger and Abia States as listed below.

SN STATE DATE REMARK

1 Osun 3rd May HMH launched the BHCPF enrolment of beneficiaries in Osun

2 Niger 10th May HMH launched the BHCPF enrolment of beneficiaries in Niger

3 Abia HMH launched the BHCPF enrolment of beneficiaries in Abia

5.1.1.2 Baseline Assessment

A key requirement for the take of implementation for the Basic Health Care Provision Fund

(BHCPF) was the establishment of baseline data through the assessments of selected

facilities in participating States. The Implementing Gateways and Secretariat to the National


Steering Committee (NSC) in partnership with the HP+ convened a one-day ToT on BHCPF

Facilities Assessments with participants from the implementing entities. The training was

held on 6th March, 2019 at the Hawthorne Suites, Wyndham Street, Garki, Abuja.

The Primary Objectives of the workshop were:

• To share experience and lesson learnt from baseline assessment in Abia, Osun and Niger

• To appraise participants with the facility assessment methodology and tools, configuration of mobile form on devices for assessment, enumerators training, supervise the assessment process and data quality control in the States.

5.1.1.2.1 Desk review of the Baseline Assessment Report of the four (4) States Abia, Ebonyi,

Osun & FCT

The Program Lead directed the desk review of baseline assessment report of the four (4)

States Abia, Ebonyi, Osun & FCT following the request by the states for approval and

authorization to disbursed fund to PHC facilities after completion of baseline and capacity

building for health workers and WDC. This was conducted on 2nd to 4th October 2019 at the

NPHCDA Conference Room, Asokoro Annex Office.

The Objectives includes:

• To identify specific issues/challenges in state and the selected PHC

• To determine the number of eligible PHCs to receive fund The specific issues/challenges identified in the four (4) state were identified as

infrastructures, duplicate or no bank account, HRH and PHC with no baseline report etc. and

the tentative list of non-eligible and eligible PHCs to receive BHCPF fund were line-listed to

serve as guidance and subject of discussion during the proposed states verification visit.

5.1.1.3 Capacity building (NToT)

5.1.1.3.1 Mid-Level Staff Orientation Workshop on the BHCPFOperations

In continuation of efforts by the BHCPF implementing gateways (NPHCDA and NHIS) and

supporting partners to enhance the capacities of a wider section of their staff on BHCPF,

capacity building was planned and conducted for mid-level staff of the two (2) gateways to

bring them up to speed and acquaint them on the concept of the BHCPF. The training was

supported by HP+ and facilitated by the implementing gateways Program Implementing

Unit at Bolton White Hotel, Garki, Abuja on the 28th - 29th March, 2019. Participants were

drawn from NPHCDA and NHIS both from Headquarters and the roll-out states (18 states

plus FCT). A total of 35 mid-level staff in the Agency were trained/orientated on BHCPF.


5.1.1.3.2 NToT for 1st& 2nd Cohort

In preparation to actual take off and implementation of the BHCPF in Nigeria, NPHCDA,

stakeholders and partners organizes capacity building targeting National trainers (NToT) to

have a pool of facilitators to further cascade to state trainers was conducted in Osun and

FCT, Abuja as listed below:

SN Activity Sponsor Date

1 1stCohort NToT HP+ 19th – 24th April

2 2nd Cohort NToT HP+, MNCH2 & WHO 10th - 14th June

5.1.1.3.3 SToT for States of Abia, Ebonyi, Osun, FCT, Ebonyi, Yobe, Kano, Kaduna, Katsina,

Bauchi, Delta, Niger, Edo, and Jigawa State

In preparation to actual take off and implementation of the BHCPF in Nigeria as the NPHCDA

disbursed fund to the state, a training targeting National, State and LGA trainers (NToT & SToT) to

further cascade the PHC workers and WDCs was conducted in Osun and Abia States as listed below:

The goal of the training was to strengthen the capacity of a core group of staff of the Gateways and

partners to be able to cascade the BHCPF training to the State and Health facility/WDC level.

5.1.1.4 Health Financing Courses

5.1.1.5 States Engagement

5.1.1.5.1 State Engagement with SPHCBs (States in receipt of 1st& 2nd tranche disbursement

of the BHCPF)

The NPHCDA provides oversight for 45% of the BHCPF, which is meant for improving the

operational effectiveness and quality of service of Primary Health Care Centers. With the

recent initial release of N12.7 billion to the National Secretariat (FMoH), the NPHCDA began

the disbursement funds administered through it to an initial set of 8 states and the Federal

Capital Territory (1st tranche) and second set of states (2nd tranche). The specific objectives

of the States engagement to the SPHCBs that received 1st& 2nd tranche disbursement of the

BHCPF were:

• To review and verify the documentations of the PHCB to ensure their readiness for the operationalization of the BHCPF

• To identify and train operators on the use of the Remita platform to enable the Primary Health Care Boards (PHCBs) of each state to access the funds that have been transferred to their Treasury Single Account (TSA)

• To Facilitate the development of the BHCPF work plan for each PHCB.


SN ACTIVITIES STATES DATE REMARKS/NEXT STEP

First State

Engagement

in the Nine

State

(States in

receipt of 1st

tranche

disbursement

of the BHCPF)

Abia, Osun,

Niger,

Anambra,

Kano, Edo,

Kaduna,

Delta and

FCT

17TH – 21ST

June 2019

Follow up with each state to obtain pending

information and materials for NPHCDA’s

documentations.

There is need to start capacity building of health

workers so that funds disbursed can be

effectively deployed for the intended purposes

The federal ministry of health is yet to share the

report of the baseline assessment of primary

health care facilities in most states. The reports

need to be made available promptly to enable

the effective commencement of the programme

Second State

Engagement

in the State

(States in

receipt of 2nd

tranche

disbursement

of the BHCPF)

Adamawa,

Bayelsa,

Benue,

Ebonyi,

Nasarawa,

Kwara and

Plateau

22nd – 25th

July 2019

Follow up with each state to obtain pending

information and materials for NPHCDA’s

documentations.

There is a need for the state to move quickly to

meet up with all requirements and for capacity

building of health workers to be conducted so

that funds disbursed to state TSA can be

effectively deployed to facilities.

In states with NSHIP e.g. Nasarawa, there is need

for the stakeholders to decide whether to use

the NSHIP facilities for the BHCPF or select a new

set of facilities

5.1.1.6 National Steering Committee (NSC) Meeting of BHCBF The Meeting took place on the 14th of October, 2019 at FMoH Conference Room with the following

Objectives:

• To provide an update to members of the National Steering Committee (NSC) on fund flow and Implementation activities of the BHCPF programme as at October 2019.


• To update the National Steering Committee on the activities carried out to date in engaging Independent Verification Agents (IVA) and the External Auditor (EA) for the programme.

• To seek the approval of the National Steering Committee to disburse funds to states that are yet to receive funds under the programme.

Outcomes:

The HMH and Steering Committee members ruled and installed the 25% Counterpart Fund by

the State Governments through SPHCB for infrastructure and HRH development as Stated in

the NHAct 2014.

The NSC was updated on fund flow and Implementation activities of the BHCPF programme

as at October 2019. Specifically, the NSC is invited to note that:

• A total sum of N13.8bn has been disbursed to NHIS, NPHCDA, DHS and NCDC TSA accounts following the approved criteria by the National Steering Committee

• The NPHCDA Gateway has further disbursed N5.55bn and N100.2m as programme and operational funds respectively for the next four (4) quarters to the TSA accounts of sixteen (16) SPHCBs.

The disbursement was made in two tranches as highlighted below:

• 1st tranche - N3.85bn (N3.79bn being programmatic and N61.99m being operational) disbursed on the 23rd May 2019 to nine (9) States namely: Abia, Anambra, Delta, Edo, Kaduna, Kano, Niger, Osun and FCT.

• 2nd tranche - N1.81bn (N1.76bn being programmatic and N48.21m being operational) disbursed on the 28th June 2019 to seven (7) states namely: Adamawa, Bayelsa, Benue, Ebonyi, Kwara, Nasarawa and Plateau.

• These States are divided into two (2) categories: I. States that have received funds from just one of the implementing gateways. These states are Bauchi, Benue, Imo, Katsina, Lagos, Oyo, Yobe, Nasarawa, and Kwara. II. Other states that have recently met or on the path to meeting the disbursement criteria.

The members were updated on processes and status of engaging Independent Verification

Agents (IVA) and the External Auditor (EA) for the programme:

• The ToR, Procurement approach and other relevant documents have been developed for the engagement of the IVA and EA, with a NO objection obtained.

• Funds for the professional fees of the IVA and the EA will be sourced from the Government of Nigeria, the World Bank, and Bill & Melinda Gates Foundation


The NSC did not approve disbursement of funds to the Gateway and States that are yet to

receive funds under the program.

6.1.1.7 FINANCIAL DISBURSEMENTS

(A) Disbursement of Programmatic funds to States through NPHCDA Gateway

Figure 15: Disbursement of BHCPF Programmatic Funds through NPHCDA Gateway

(B) Readiness checklist of the NPHCDA gateway (Status as @ 8TH Jan, 2019)


Table 12: Readiness Checklist of NPHCDA Gateway


The above listed activities and workshops was supported by the NPHCDA BHCPF PIU for the period

under review in collaboration with the NSC secretariat and National Health Insurance Scheme as well

as financial/technical support from partners.

General Challenges

• Inadequate technical officer in the PIU

• Inadequate operational fund for take off (office set up, program vehicles, PHC baseline assessment, Capacity building, ISS and Quality Assessment) at the National

• States (specially, Abia, Osun & Niger) don’t have any operational funds

• Delay in fund release (both from FG account and WB support to three (3) States)


Recommendations

• Deployment of technical officer to the PIU

• Advocacy for partner support and increase operational fundingEarly release of funding

• Needs to advocate to Partners (WB) to release operational funds for Abia, Osun & Niger.

Executive Director NPHCDA, HMH, HMSH at FMoH

at NSC Meeting in 2019

HMH Giving BHCPF Cheque to the Deputy Gov. of

Niger State


B. Financial Report


B. Financial Report

In year 2019 under review, NPHCDA continues the implementation of the recommendation of KPMG

in conjunction with the restructuring of Finance and Accounts Department in Ministries, Department

and Agencies as stipulated by the office of the Accountant general of the Federation (OAGF) leading

to the newly created divisions of the department included:

• Expenditure Division

• Budget Division

• Financial and Fiscal Reporting Division

• Revenue and External Assistance Division

REVENUE:

The total revenue received for the first three quarters of the Year 2019 (January-Sept 2019)

was N122,109,737.75which was mainly from the receipt for Recurrent/Overhead. From the

2018 Capital release, the sum of N17,667,668,538.46 was for 2018 rolled-over to the year

2019. These forms part of the entire release for the year 2018 as the Appropriation for 2019

fund was partly received in the fourth quarter of 2019 amounting to 3.3 Billion Naira.

EXPENDITURE:

The total expenditure of the Agency for the first three quarters of 2019 was N91,526,467.23

for the recurrent expenditure while that of Capital Expenditure isN17,641,746,994.63.

Other key achievements are as follows:

• Audit of 2018 Financial Statement for the Agency as concluded as copies of the has been submitted the relevant/statutory stakeholders

• Stock Verification and Stock taking Exercise was successfully carried out for the mid-year 2019

• Prompt Compilation and Preparation of the Agency Budget for year 2020

• Assets Verification and Tagging Exercises for the Agency Assets as successfully completed within the year

• Successful Retrieval of GAVI Funds Retirements documents and Fund Balances in Abia, Anambra, Kano, Ondo, Oyo and Rivers State respectively.

• Prompt submission of interim financial reports (IFR) and IPSAS Accrual Trial Balance (TB) on the Agencies World Bank funded projects to then bank and other stakeholders.

• Early Procurement of treasury Non-Security Documents, Accounting forms, Journals, Registers etc for ease documentation of the Agencies financial transactions.


STAFF PRODUCTIVITY

AWARDS/SEND FORTH FOR

RETIRED OFFICERS; NPHCDA

ANNUAL SPORTS

COMPETITION AND GIVING

BACK TO THE COMMUNITY


7.0 STAFF PRODUCTIVITY AWARDS/SEND FORTH FOR RETIRED OFFICERS;

NPHCDA ANNUAL SPORTS COMPETITION AND GIVING BACK TO THE

COMMUNITY

The NPHCDA Leadership has institutionalized Staff Productivity Awards/Send Forth for

Retired Officers and also the Annual PHC Sports Competition. The 2019 Edition of the Staff

Productivity Award was the third following the Maiden Edition in 2017. Similarly, the 2019

annual Sports was the Second edition after the first in 2018. Dr Faisal Shuiab, the Executive

Director NPHCDA promised to sustain these activities and true to his words it happened for

the third and Second time in 2019 after the Maiden edition of 2018.

7.1 Staff Productivity Awards and Send Forth for Retired Officers

Scenes from Staff Productivity Awards and Send Forth of Retired Officers, Abuja; 2019


7.1.1 NPHCDA Annual Sports Competition

Scenes from NPHCDA Annual Sports Competition, Abuja; 2019


7.1.2 Giving Back to the Community The NPHCDA family were in Gboko, Benue State on the 12th of October, 2019 to Commission

the renovated and equipped Maternity Centre in honour of Dr. Eugene Ivase, former

Director, Advocacy and Communication Department, as recipient of the 2018 Executive

Director/CEO’s award – tagged “Giving Back to the Community”. On the 5th of December,

2019 they were in Kano to honour Dr Laila Umar of the Department of CHS for a similar

event.

Scenes of “Giving Back To the Community” Gboko, Benue State; 12th October, 2019


Scenes of “Giving Back to the Community” Kano, Kano State; 5th of December, 2019


ANNEXURES:

Annex I: Communique from 62nd NCH Asaba, delta State

1. Following extensive deliberations, the Council considered a total of 65 memoranda,

approved 26, noted 24 and stepped-down/withdrew 15.

The following resolutions were approved:

I. Federal, 36 states, FCT and health stakeholders should adopt the National Council

on Health handbook as a guide on all National/State council on health matters in

Nigeria.

II. The Federal Ministry of health should continuously build the capacity of relevant

officers at all levels on NCH matters including writing of good quality NCH/SCH

memoranda;

III. The ten-year compendium on NCH resolutions should be used as a score card for

evaluating the impact of NCH meetings

IV. All Departments, Agencies and Parastatals of the Federal and State Ministries of

Health should develop Annual Operations Plans (AOPs) on or before 3rd quarter each

year to inform annual budget development and to demonstrate the

operationalisation of the NSHDP II;

V. Federal Ministry of Health to continue monitoring the implementation of the

NSHDP II at all levels and report progress to Council at every council meeting;

VI. Federal, 36 states and FCT should ensure Development Partners supporting the

implementation of the NSHDP II key into the AOP regime as part of their support;

VII. Federal, 36 states and FCT should adopt and commence implementation of the

National Health Promotion Policy (2019);

VIII. All Development partners and Civil Society Organisations to endorse the Country

Compact committing to the implementation of the National Strategic Health

Development Plan II;

IX. The FMOH to commence provision of technical support to all states for the adoption

and implementation of the National Roadmap for accelerating reduction of

Maternal and Neonatal mortality in Nigeria at all levels and the designation of Desk

Officers at both the Federal and State levels;

X. Federal, 36 states and FCT should adopt and commence implementation of the

National Noma Policy and three-year Noma action plan for Nigeria (2019 – 2021) and

identify more centres for establishment;

XI. Federal, 36 states and FCT should adopt and commence implementation of the

National Policy and Strategic Plan for Ear and Hearing Care (EHC) at all levels;

XII. State Coordinators for EHC activities should be appointed in all 36 State Ministries of

Health and FCT to work with the Desk Officers on EHC at the Federal Ministry of


Health;

XIII. Federal, 36 states and FCT should adopt and commence implementation of the

National Quality of Care Strategy for the reduction of Maternal and Neonatal

mortality at all levels;

XIV. The NHREC should establish an electronic platform (e-platform) for protocol

submission and review;

XV. The NHREC should commence charging of 0.5% of grant value as fees for submission

and review of protocols from researchers;

XVI. Federal, 36 states and FCT should observe World Food Safety Day (WFSD)

celebration and activities at all levels;

XVII. All 36 States and FCT should establish Traditional, Complementary and Alternative

Medicine Department/Boards to enhance coordination, regulation and control of

TCAM practice and its products in Nigeria;

XVIII. Federal, 36 states and FCT should ensure appropriation of adequate funds for polio

eradication and routine immunization to enable the polio eradication

programme sustain its high impact interventions to finally achieve certification and

a polio free status;

XIX. 36 states and FCT should establish or reactivate State/LGAs Task Forces on

Immunization (STFI/LGTFIs) to provide the needed coordination and oversight at the

state and LGA levels as well as for Council to interface with Governors and Chairmen

of LGAs with identified low commitment;

XX. Federal, 36 states and FCT should engage with development partners working in

states to develop a transition mechanism by end of 1st quarter 2020 to cushion the

effects of the global ramp down of polio resources which inevitably leads to lay off

of several development partners agencies’ members of staff, as we move closer to

certification;

XXI. Federal, 36 states and FCT should adopt and commence implementation of the

National Eye Health Policy at all levels and the designation of Eye Health desk officer

to interface with the National Eye Health Programme;

XXII. Federal, 36 states and FCT should adopt and commence implementation of

Treatment Guideline for Child Eye Health at all levels of government by all

stakeholders in the Nigerian Health Sector;

XXIII. All 36 states and FCT should establish State DR-TB treatment compliance teams;

XXIV. Federal, 36 State Ministries of Health and FCT Health Secretariat should create Legal

Units where none exists and create and institutionalize a MEDICO-LEGAL WEEK to

create awareness on legal issues in health;

XXV. FMOH should repurpose of the national coordination architecture for health sector

response to humanitarian crisis to provide normative guidance for processes


geared towards improving health outcomes for populations within fragile settings;

XXVI. Federal, 36 States and FCT to improve health outcomes within fragile setting by

strengthening and scaling up present response modalities;

XXVII. FMOH in collaboration with states and other relevant stakeholders should develop

a national policy document for the health of refugees, migrants and internally

displaced persons;

XXVIII. FMOH should set up and operationalise systems to collaborate with the Ministry of

Humanitarian Affairs, Disaster Management and Social Development in the

provision of relevant technical support for health in humanitarian crisis, and

disaster management;

XXIX. Federal and State Ministries of Health to prioritize the provision of Water,

Sanitation and Hygiene services in health facilities across the country by creating a

budget line or increasing budgetary allocation for Water, Sanitation and Hygiene;

XXX. Federal Ministry of Health should develop a policy that will guarantee free

treatment for all Leishmaniasis patients, the inclusion of Leishmaniasis treatment

into procurement plan/budget of the Ministry of Health for the purchase of drugs on

annual basis and that development partners working in the State support the

initiative;

XXXI. All State Ministries of Health and Agriculture and Rural Development, Departments

and Agencies to create budget lines for training of staff as field epidemiologists in

the Nigerian Field Epidemiology and Laboratory Training Programme;

XXXII. All tertiary and specialist hospitals in Nigeria should procure and ensure a continuous

supply of basic antidotes in their hospitals;

XXXIII. All tertiary and specialist hospitals should establish functional poison centres in all

satellite hospitals or clinics that are affiliated to tertiary hospitals and in all states

of the federation to improve access to medical management of poisoning;

XXXIV. All states and FCT should establish data quality “control rooms” domiciled in their

Primary Health Care Boards (PHCBs) for stakeholders to address challenges relating

to service delivery on DHIS2 for the enhancement of decision making through the use

of quality data;

XXXV. FMOH should disseminate the report of the 2017 NHA as validated by stakeholders

from the 36 States and FCT;

XXXVI. 36 States and FCT should adopt Workload Indicator of Staffing Needs (WISN) tool

for the assessment of Human Resource for Health needs and distribution at all levels

of the health sector;

2. Council noted that 35 States of the Federation and FCT were represented.


3. Council appreciated the support and hospitality extended to it by the Government and

people of Delta State.

4. Council further appreciated the role of Development Partners in health, Civil Society

Organisations, the media and other stakeholders for their contribution towards the

success of the meeting.

5. Council agreed that the 63rd NCH will hold in Ondo State in June 2020.

CONCLUSION

6. A motion for adjournment was moved by the Honourable Commissioner for Health,

Borno State and seconded by the Honourable Commissioner for Health, Cross River

State.

7. The 62nd Session of the NCH was formally closed by the Chairman of Council

following the vote of thanks by the Director, Health Planning, Research and Statistics,

Federal Ministry of Health, Dr Meribole.

Annex II: 2019 Seattle Declaration


1. Clear commitments to fully implement Primary Health Care Under One Roof (PHCUOR) – per the recommended actions defined in the PHCUOR scorecard 2019, e.g. stronger workforce planning through the initial step of the transfer of PHC staff from LGAs, SMOH, MLG&CA, LGSC etc to State Primary Health Care Boards (SPHCBs). NPHCDA should provide technical assistance in support of processes leading to the full implementation of PHCUOR.

2. Understand the need for a fully costed minimum service package (MSP) tailored to

state realities (e.g. fiscal space, number of workers, number of facilities) as a way of attaining the ward minimum health care package – then develop and implement such an MSP

3. Fulfil all associated Basic Health Care Provision Fund (BHCPF) state requirements

(e.g. state counterpart funding)

4. Governors commit to review state PHC performance on a quarterly basis in State Executive Council meetings

5. Attend Q1 2020 summit to discuss PHC action plan – with the goal of articulating a

compelling vision for sustainable PHC investment in Nigeria

In addition, we commit to the following asks for Polio and Routine Immunization (RI):

6. As listed in Abuja Commitment, active leadership and commitment of Governors re: immunization programs

o Be personally and actively involved o Release counterpart funding on time – at least 1 week prior to start of

campaign o Make sure the LGA chairman is accountable e.g. ensuring that they chair

daily evening review meetings during campaigns

7. Strong state task force on PHC and immunization; should involve regular meetings chaired by Deputy Governors, driving and tracking on quality of RI services and campaigns, and reporting out each quarter at a minimum

8. Engagement of traditional and religious leaders around PHC – endeavor to motivate

and mobilize around PHC

9. National Economic Council (NEC) should have polio and RI as specific agenda items each month between now and June 2020. NEC should monitor aggressively and identify gaps, keeping the pressure on and driving the program to a successful conclusion.
