Background My name is Zakari Usman, I am the state Program Manager for CIHP, kogi. I'm responsible for all the CIHP operations in Kogi State. This includes technical intervention of facilities, financial management, Human resources, managing relationship with Government and stakeholders as well as other partners in the state. In summary, I am responsible for all of CIHP's operations and feasibility in Kogi State.
ABOUT CIHP
CIHP is an acronym for Center for Integrated Health Programs, it is an acronym for the Center for Integrated Health Programs, it is a leading indigenous Non-Governmental Organization established to promote better health for Nigerians and basically what we do is create strong and sustainable health systems through partnership using HIV as an entry point to health systems strengthening. Partnership is one word that we use repeatedly because most of the things we do are done through partnership. We evolved from an international NGO the Colombian International Center for AIDs Program (ICAP).
ICAP has been in Kogi State since 2007/2008 as an international NGO but in 2011 at the instance of our funders which is the United States Government through the Center for Disease Control (CDC) we transited and became completely indigenous in 2011. We are a hundred percent indigenous, non-governmental, non-religious, non-political organization. We have continued to support family centered highly focused high quality Comprehensive HIV/AIDs care and treatment. We are a Center for disease control (CDC) implementing partner funded through Presidents’ Emergency Plan for AIDs Relief (PEPFAR) for the BRIDGES PROJECT.
We are the Lead implementing PEPFAR/GF Partner in all the states that work with CIHP. CIHP has its headquarters in Abuja, we work in four states namely; Kogi, Kaduna, Gombe and Benue states.The PEPFAR Fund is a US government public health intervention for HIV/AIDS, it began in 2004 to mitigate the impact of HIV in resource poor and high burden countries,Nigeria is one of the benefitting countries. We have supported most health facilities in the state beginning with one facility then expanding to four facilities later seven facilities until we scaled up and were in almost all the local governments in the state. This was until the concept of rationalization was introduced by our funders. Rationalization meant that the US Government wanted just one implementing partner and one agency in each state for reasons of accountability.
Until recently we were supporting 34 comprehensive health facilities and about 239 primary health care facilities and four CBO's but the numbers have reduced to 12 comprehensive facilities and 34 primary health facilities that are sustained using the recent PEPFAR/CDC guideline.
BREAK THROUGHS AND ACHIEVEMENTS
Since inception 500,000 persons have been counseled and tested for HIV/AIDS in kogi State, equally too over 126,000 women who attend antenatal clinics during pregnancy have also been screened for HIV and availed Prevention of Mother to Child transmission of HIV (PMTCT) Services, Over 2600 women have been provided with Anti-retroviral drugs that will prevent infection of HIV from mothers who are HIV positive to their children.
We currently have over 14,000 persons across all the health facilities that we support taking Anti-Retroviral Drugs for their health. We have equally intervened in the areas of health system strengthening intervening in all the six building blocks; that is service delivery, health care finance, health management information system, drug vaccines and technology and leadership and governance.
We met facilities in dilapidated states which we have upgraded (tiling, roofing, restructuring) etc. We have supplied almost all of the facilities we support with power generating plants, some boreholes and also resusciteurs to some facilities; we have also supplied laboratory equipment worth millions that are used for Hematology and chemistry, including CD4 machines for people who are HIV positive.
CIHP has continually provided trainings and mentorship for the health workforce in the facilities and the ministries and Hospital management board. We train them on HIV/AIDs prevention, treatment and care, TB/HIV activities, Pharmaceutical care and logistics management, Laboratory services for use of the supplied machines to trouble shooting and quality assurances, clinical systems mentorship, integrated supportive supervision as well as leadership and management not forgetting of course monitoring and evaluation. As I speak with you we still provide support for them for continuing medical education such that they are continually abreast with cutting edge findings.
In the past, we employed Doctors, Pharmacists, Nurses and Laboratory Scientists and other cadres of staff that were providing services across government facilities. For leadership and governance, we have trained management of the State Ministry of Health, Kogi State Agency for the Control of AIDs (KOSACA), Hospital Management Board and State Health Primary Health Care Development Agencies (KSPHCDA). We embark on scheduled joint mentoring and supportive supervisory visits with select members from the Ministry of Health, Hospital management board and KOSACA so that that they see what we do. We do this to transfer skills to them and let them see firsthand the things we do and how we do them.
In the area of orphans and vulnerable children there is a lot of support for them, in times past we used to pay school fees buy school uniforms, school bags and enroll orphans and vulnerable children in schools. Now we have moved from that to block granting, by block granting we identify a school where there are orphans and vulnerable children and have an agreement, we have a committee for it. We discuss the dire needs of the school, toilets, leaking roofs, furniture, and broken windows. We look for a capital project instead of paying cash we now decide on what to do for the school and the advantage of this is that when you pay school fees, buy uniforms and all that the child can go to school for that term for which you have paid the fees, next term you pay again. What happens when there is a problem with funding? Or if the project priority changes based on the funders dictate or you come to the end of the programs life span and these children have not graduated from school. What we do now is block granting where we have an agreement with the school to carry out the structural repairs or equip library or even buy instructional material so that a number of children will be enrolled and go through the six years of primary education without paying school fees. And for children who are heads of households, because we can’t send this demographic to school, we develop their skills by training them on marketable skills like ICT, hair dressing, fashion design among others. For the caregivers of the people living with HIV/AIDs we have the village savings and loans scheme where we organize them in such a way that they become a formidable group that can access funds, some groups have farms etc.
INSIGHT INTO BRIDGES PLUS AND SCOPE PROJECTS
BRIDGES is our CDC treatment and care program. BRIDGES is an acronym for Bridging the Gap and Ensuring Sustainability. It is a grant from CDC to provide treatment and care, almost all the treatment and care I mentioned earlier is from this grant. The SCOPE is another CDC grant; SCOPE is an acronym for Strengthening Skills and Competencies of Care Providers for Enhanced Service delivery. What we do by SCOPE is work with health training institutions in Kogi State, we have three of them namely, School of Nursing Obangede, School of Health Technology Idah, School of Midwifery at Grimard Hospital Anyigba. The essence is to provide the students with pre-services training and competencies that will enable them provide care and support to People Living with HIV (PLHIV) after graduation from these institutions.
Digressing a bit from Kogi State we are also working with the Federal Ministry of Health to develop a health work force information system. We have an electronic registry of the entire Health workforce in the country working with regulatory bodies, nursing and midwifery council, Nigerian Medical and Dental council, Medical Laboratory council, Pharmaceutical council to have a bank of the entire health workforce. A large number of them have already been captured in the Federal ministry of health data base so that we can have a basis and statistics that can help us make appropriate policies backed with evidence. We have also worked with the Medical and Dental Council of Nigeria to reduce the stress of registering for their licenses. Before now, registration was done manually at the State Ministries of Health or in Abuja at the Medical and Dental Council of Nigeria office, now you can do the registration online conveniently at the comfort of your offices. All this was because of the intervention of CIHP through the SCOPE project.
FUTURE PROSPECTS FOR CIHP PROJECTS IN KOGI STATE
We are implementing partners and as implementing partners we work with grants but we also work with other corporate funders like the MTN Foundation in some states. The MTN Yellow Doctor provides basic medical care; there is a van with life support machines and clinical services items that moves from community to community providing basic medical services. MTN supports CIHP with counterpart from state, we are just about to close the SCOPE program with all these gigantic achievements I mentioned earlier. We are still on with the BRIDGES PLUS project till 2017 and hope to be around for as long as there are newer projects under which Kogi is covered.
CHALLENGES FACED SINCE CIHP IMPLEMENTATION IN KOGI STATE
Like every other development work we have had a number of setbacks, chief amongst them is the lack of political will. Over the years there have been a lot of issues with the funding for health as a development partner we are supposed to help bridge the gap while the government takes the driving seat, but as it is we have been at the fore front in almost all the interventions. For example apart from PEPFAR, Global Fund and support from World Bank the states’ contribution to HIV/AIDs response has been embarrassingly low. That goes to say that we are constrained because there is a limit to what we can do but if we have the Government doing its own part in terms of policy implementation, financing the budget for health, we may not have most of the challenges that we have and more funds will be free for service provision. The second challenge is the attitude of health care workers; most of the health care workers see the HIV/AIDs program, the Tuberculosis program and malaria program as not being part of the integral core of the hospital deliverables. When you come to mentor them and give them support, they see it as your problem.
There is also gross human resource inadequacy, some facilities are understaffed, some are redundant, in some facilities you have 8 Admin staff and 2 nurses, and there is lopsidedness in the distribution of health care workers. Heath workers are poorly motivated, in a situation where somebody works for six months and is not paid it is very demotivating, some of them begin to absent themselves from work and you can’t blame them. This also leads to incessant strike actions, the strike actions leads to the loss of patients who are lost to follow up.
FUNDING AND PARTNERSHIPS
CIHP partners with the Federal Government, the State Government otherwise we will not be able to be here. There is nothing that we do here that the state government is not aware of. We also partner with other organizations; we have four community based organizations that we partner with because we cannot implement all of our programs our self. The Orphans and Vulnerable Children program is one of the programs that we sub granted to the CBOs. We also partner with health facilities and other development partners to ensure that there is synergy with the people we serve. Our partnership cuts across the Federal Government, State Government, other development partners, and community based organizations, religious bodies and private organizations. On fund generation we as implementing partners get our funds from CDC based on the response for Request for Application (RFA), and we also get funding from Global Fund. The funding processes are open and competitive for all implementing partners.
