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Borno State Report
HEALTHCARE SERVICES IN UNFPA ASSISTED STATES OF
NIGERIA
PREPARED BY
UNFPA NIGERIA COUNTRY OFFICE
NOVEMBER 2010
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TABLE OF CONTENTS
Page
Cover Page 1
Table of contents 2
List of Acronyms 4
List of Tables 5
List of Figures 7
1. INTRODUCTION 8
1.1 STATE CONTEXT 8
1.2 BACKGROUND TO THE ASSESSMENTS 9
1.3 AIM AND OBJECTIVES OF THE ASSESSMENTS 10
2. METHODOLOGY 10
2.1 SAMPLE SELECTION 10
2.2 QUESTIONNAIRE DEVELOPMENT AND ADMINISTRATION 11
2.3 LIMITATION OF THE ASSESSMENTS 11
3. RESULTS OF THE ASSESSMENTS 11
3.1 BACKGROUND INFORMATION 11
3.1.1 Designation of respondents 11
3.1.2 Types of facilities 12
3.1.3 Residential status of facilities 13
3.1.4 Physical status of facilities 14
3.1.5 Methods of Waste Management 19
3.1.6 Common RH problems 19
3.2 HUMAN RESOURCES 19
3.2.1 Availability of health workers 19
3.2.1.1 Skilled Health Workers 22
3.2.1.2 Unskilled Health Workers 28
3.2.1.3 Other Health Workers 31
3.3 TYPES OF TRAINING ATTENDED BY HEALTH WORKERS 37
3.4 HEALTHCARE SERVICES PROVIDED BY FACILITIES 37
3.3.1 ANC, Delivery Care and PNC Services 38
3.3.2 Child Welfare and Immunizations Services 39
3.3.3 Family Planning Services 40
3.3.4 STIs, HIV Counseling and HIV Testing Services 41
3.3.5 Obstetric Fistula Repair 41
3.3.6 Treatment of Minor Ailments 41
3.3.7 Referral Services 42
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3.3.8 Demand creation activities 42
3.3.9 Other Services 43
3.5 PROVISION OF SERVICES IN THE LAST THREE MONTHS 43
3.5.1 Total Attendance for Services 43
3.5.2 Family Planning Services, Contraceptives and Stock Outs 46
3.5.2.1 Availability of FP Services 46
3.5.2.2 Number of FP Acceptors 47
3.5.2.3 Stock out status 48
3.5.2.4 Type and number of Contraceptives 49
3.5.2.5 Number of FP complications referred 50
3.5.2.6 Availability and Adequacy of FP Rooms 51
3.6 AVAILABILITY OF INTEGRATED SRH AND HIV SERVICES 51
3.6.1 Provision of Integrated SRH/HIV care and Services 51
3.6.2 Types of Integrated SRH/HIV care and Services 51
3.7 EMERGENCY OBSTETRIC AND NEW BORN CARE SERVICES
3.7.1 Basic Emergency Obstetric and New Born Care Services 52
3.7.2 Comprehensive Emergency Obstetric and New Born Care Services 52
3.7.3 Total obstetric complications in the last three months 54
3.7.4 Other requirements for EmONC services 55
3.7.4.1 Availability and utilization of Referral Forms 58
3.7.4.2 Provision of Birth Preparedness Services 59
3.7.4.3 Functional Means of Transport for Emergencies 59
3.7.4.4 Availability of Maternity Beds and Delivery Equipment 60
3.7.4.5 Availability of Essential Drugs and Consumables 62
3.7.4.6 Methods of Sterilization. 62
3.8 DATA COLLECTION FORMS, SUPERVISION AND SUPPORT
3.9.1 Availability, utilisation and transmission of RH/FP data forms 63
3.9.2 Other statistical data forms 64
3.9.3 Types of IEC Materials 64
3.9.4 Supervision of facilities by LGAs 64
3.9.5 Village Health Committees 65
4 RECOMMENDATIONS 66
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LIST OF ACRONYMS
ANC
CPAP
CPR
FCT
FP
HIV/AIDS
M&E
MDG
MICS
MMR
MNCH
NDHS
RHR
SRH
TFR
UN
UNFPA
ZO
Antenatal Care
Country Programme Action Plan
Contraceptive Prevalence Rate
Federal Capital Territory
Family Planning
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Monitoring and Evaluation
Millennium Development Goals
Multiple Indicators Clusters Survey
Maternal Mortality Rate
Maternal and Neonatal Child Health
National Demographic and Health Survey
Reproductive Health and Rights
Sexual Reproductive Health
Total Fertility rate
United Nations
United Nation Population Fund
Zonal Office
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LIST OF TABLES
Table 3.1: Frequency Distribution of Respondents by rank and profession
Table 3.2: Indicators of the Physical Status of HCFs in the State
Table 3.3: Common RH problems in the State
Table 3.4: Frequency distribution of health workers by types of health care facilities
and nature of residence
Table 3.5: Frequency distribution of skilled health workers by types of health care
facilities and nature of residence
Table 3.6: Frequency distribution of Doctors by types of health care facilities and
nature of residence
Table 3.7: Frequency distribution of Nursing and Midwifery staff by types of health
care facilities and nature of residence
Table 3.8: Frequency distribution of unskilled health workers by types of health care
facilities and nature of residence
Table 3.9: Frequency distribution of pharmaceutical health workers by types of
health care facilities and nature of residence
Table 3.10: Frequency distribution of laboratory health workers by types of
healthcare facilities and nature of residence
Table 3.11: Frequency distribution of other health workers by types of health care
facilities and nature of residence
Table 3.12: Percentage Distribution of the Types of Services by the Types of
supported Facilities and how frequently the services were provided
Table 3.13: Frequency distribution of attendance for some health care services in the
past 3 months (June-August 2009) by type of facility and nature of residence.
Table 3.14: Frequency Distribution of FP clients in the last three months by the types
of acceptors, residence and types of facilities.
Table 3.15: Distribution the types and numbers of contraceptives available
Table 3.16: No of FP complications referred by types of facilities and residence
Table 3.17: Types of Integrated SRH/HIV&AIDS services provided by Type of HCFs
Table 3.18: Availability of Basic Emergency Obstetric and Newborn Care Services in
the selected HCFs
Table 19: Summary of reasons for not providing BEmONC
Table 3.20: Provision of CEmONC service in the supported HCFs in the State
Table 3.21 Summary of reasons for not providing CEmONC
Table 3.22: Number of Obstetrics Complications.
Table 3.23: Types of obstetric complications
Table 3.24: Percentage distribution of Facilities that had Referral Forms by the
reasons for non-utilisation of these referral forms
Table 3.25: Names of Health Facilities where referrals are made in the State
Table 3.26: Provision of Birth Preparedness Services by the Types of HCFs
Table 3.27: Availability of Functional Means of Transport
Table 3.28: Type of, who provided and maintained the functional means of transport
Table 3.29: Availability of maternity equipment in health facility by types of beds,
residence and facility types
Table 3.30: Availability of RH/FP data forms by the Types of HCFs and where data is
sent to
Table 3.31: Distribution of IEC materials available in the facilities
Table 3.32: Supervision of HCF by officials of the LGA department
Table 3.33: Existence, Functionality and Meetings of VHCs
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LIST OF FIGURES
Figure 1.1: Map of Nigeria showing the location of Borno State
Figure 3.1: Percentage distribution of respondents by profession
Figure 3.2: Percent Distribution of Supported Health Care Facilities by Types
Figure 3.3: Percent Distribution of Respondents by Nature of Residence
Figure 3.4: General Cleanliness of the Facility
Figure 3.5: Availability of Curtain in the Maternity Ward or Delivery Room
Figure 3.6: Condition of the floor of the Labour Room
Figure 3.7: Percent Availability of Amenities in supported HCFs in the State
Figure 3.8: Percent Availability of Toilets and Bathrooms in supported facilities
Figure 3.9: Main source of water within the premises of supported facilities
Figure 3.10: Sources of Light in the supported Facilities
Figure 3.11a: Frequency distribution of skills workers by types of facility
Figure 3.11b: Percent distribution of skills workers by residence
Figure 3.12a: Frequency distribution of Doctors by types of health care facilities
Figure 3.12b: Percent distribution of Doctors by nature of residence
Figure 3.13a: Frequency distribution of Nursing and Midwifery staff by types of health
care facilities
Figure 3.13b: Percent distribution of Nursing and Midwifery staff by nature of
residence
Figure 3.14a: Frequency distribution of unskilled health workers by types of health
care facilities and nature of residence
Figure 3.14b: Percent distribution of unskilled health workers by residence
Figure 3.15a: Frequency distribution of laboratory health workers by types of health
care facilities
Figure 3.15b: Percent distribution of laboratory health workers by residence
Figure 3.16a: Distribution of other types of health workers by the types of facilities
Figure 3.16b: Distribution of other types of health workers by residence
Figure 3.17: Percentage of the Types of facilities that offered ANC, Delivery care and
PNC services
Figure 3.18: Percentage of the Types of Facilities that Provided Child Welfare and
Immunisation Services
Figure 3.19: Proportion of the Types of Facilities That Offered FP services
Figure 3.20: STIs management, HIV counseling and HIV testing
Figure 3.21: Treatment of Minor Ailments
Figure 3.22: Referral Services
Figure 3.23: Demand Creation Services
Figure 3.24a: Frequency distribution of attendance for some health care services in
the past 3 months by type of facility and nature of residence
Figure 3.24b: Frequency distribution of attendance for some health care services in
the past 3 months by residence
Figure 3.25: Percentage availability of FP Services by the Types of Facility
Figure 3.26a: Frequency Distribution of FP clients in the last three months by the
types of acceptors and types of facilities.
Figure 3.26b: Frequency Distribution of FP clients in the last three months by the
types of acceptors and residence.
Figure 3.27: Percentage availability of Contraceptives by Types of Facility
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Figure 3.28: Percentage of Facilities Providing Integrated SRH/HIV services by the
Types of Facility
Figure 3.29: Availability of Basic Emergency Obstetric and Newborn Care Services
in the selected HCFs
Figure 3.30: Provision of CEmONC service in the supported HCFs in the State
Figure 3.31a: Number of Obstetrics Complications by Types of Facilities
Figure 3.31b: Percent distribution of Obstetrics Complications by Residence
Figure 3.32: Percentage distribution of Facilities that had and utilised Referral Forms
by the Types of HCFs
Figure 3.33a: Number of the Types of Beds in the selected Facilities.
Figure 3.33b: Percent distribution of the Types of Beds in the selected Facilities by
Residence.
Figure 3.34: Percent Distribution of selected HCFs by Methods of Sterilisation
Figure 3.35: Availability of other statistical data by the Types of HCFS
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1 INTRODCUTION
1.1 STATE CONTEXT
Borno State is a state in North-Eastern Nigeria. The State was formed in 1976 with
the capital at Maiduguri from the split of the North Eastern State. Until 1991, it
contained the present day Yobe State. The State occupies the greater part of the
Chad Basin and shares borders with the Republics of Niger to the North, Chad to the
North-East and Cameroun to the East. Within Nigeria, Borno State shares
boundaries with Adamawa State to the South, Gombe State to the West and Yobe
State to the North-West.
The State Government recognizes that healthcare the basic ingredient for socioeconomic,
technological and sustainable development. As part of its commitment to
ensuring that the people attain high standards in health; the State Government has
signed LoU with UNFPA in the 6 th Country Programme. Under the programme
UNFPA provides support to 10 designated as focal project LGAs partly increase the
low political commitment and community support for population, RH and gender
issues; and reduce the wide gender gap. Figures 1.1 below is the map of Nigeria
showing the location of Borno State.
Figure 1.1: Map of Nigeria showing the location of Borno State
.
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1.2 BACKGROUND TO THE ASSESSMENT
UNFPA Nigeria signed a Memorandum of Understanding for the 6 th Country
Programme Action Plan (CPAP) with the Federal Government of Nigeria in August
2008. The CPAP document specifies the nature of broad development assistance
frameworks of UNFPA for Nigeria in the mandate areas of UNFPA. The development
assistance frameworks of UNFPA to 12 States and the FCT are essentially in the
three thematic areas including Reproductive Health and Right (RHR), Population and
Developments (P&D) and Gender Equality (GE).
The RHR component has two outcomes and four outputs. The two outcomes are as
follows:
a. Federal, and 12+1 States’ institutions, and sectors are able to plan, implement
and monitor the delivery of quality Reproductive Health/Family Planning and HIV
Prevention services by 2012
b. Communities in 12+1 supported States are able to demand for and use quality
reproductive health/family planning and HIV prevention services by 2012.
Meanwhile, the four specific outputs expected to deliver on the two outcomes are:
a) Improved gender responsive and equitable HIV preventive services for
women and youth in 12+1 states and at the Federal level.
b) Strengthened institutional capacity to ensure reproductive health commodity
security and deliver gender sensitive and equitable family planning services at
Federal level and in 12+1 supported States’ institutions and NGOs.
c) Increased gender sensitive and culturally appropriate quality maternal health
services, including Emergency obstetric and neonatal care in 360 facilities in
12+1 supported States .
d) Enhanced knowledge, skills and mechanism to demand for, and access
quality gender sensitive and equitable RH/FP and HIV/AIDS prevention
services in selected communities in 12+1 supported States.
In order to achieve these outputs, UNFPA planned to support 30 health facilities
carefully selected to achieve a model of four primary health facilities to feed into a
secondary facility in the 12+1 supported States with view to scale up service
deliveries, increase access and utilisation of health care in the supported states, and
ensure that a model of continuum of care is available and the scale up of EmONC
and family planning in the selected local government areas. The supported health
facilities will be used as model for best practise in the provision of quality maternal
health services in these 12+1 supported State.
UNFPA Nigeria’s programme implementation adopts the principles of national
execution as prescribed by Paris Declaration. This informed the decision to embark
on the assessment of selected health facilities in the states to identify the
weaknesses and strengths of health system especially as relate to the delivery of
high quality maternal health services. This will among other things highlights
technical assistance required and the specific intervention requirement in the states
to achieve the Reproductive Health and Right (RHR) outcomes and outputs.
UNFPA collaborated with the State Ministry of Health in the supported states to
conduct the assessments of capacities of health facilities to deliver on the
reproductive health outputs in the states. The results will serve as baselines for
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UNFPA interventions, particularly in the selected facilities and in the states in
general.
This report presents the State summary of the health facilities capacity assessments
with the view to examine the status of the EOC, family planning, HIV/AIDS services
in the facilities and highlight the nature of intervention and resource requirements to
improve maternal health services at the grassroots.
1.3 AIM AND OBJECTIVES OF THE ASSESSMENT
The main objective of the assessment was to provide baseline data on the
availability and utilization of Reproductive Health services in the selected states and
thus provides the nature of specific interventions in line with UNFPA 6 th country
programme in Nigeria. The specific objectives were:
To determine the availability of Emergency obstetric services in the selected
health facilities
To determine the availability and the quality of family planning services in the
selected health facilities
To identify the quality of youth focus services in the health facilities
To identify the nature and types of problems associated with accessibility,
utilization and service delivery of maternal health care in the selected health
facility
To identify and document areas for improvement in the provision of maternal
health care delivery in the selected states
To identify gaps, strength and weaknesses in the maternal health care in the
selected states
2 METHODOLOGY
2.1 SAMPLE SELECTION
Health facilities were selected through purposive sampling approach with the
participation of the stakeholders and the programme coordinators in the State. The
State team identified six focus local areas councils from where health facilities were
chosen. Four primary health facilities and one secondary health facility were selected
from each local government area to form a module of referral health care in the local
government. Thus, 30 health facilities were selected comprising 24 Primary Health
Centers and 6 referral hospital or secondary health facilities. This report presents
results of data from 29 supported health facilities in the Borno State. This sample is
representative of the condition of maternal health care especially in the public health
facilities in the selected states
2.2 QUESTIONNAIRE DEVELOPMENT AND ADMINISTRATION
A structured questionnaire was developed featuring various questions including
EmONC, Family Planning, medical human resources, and facilities for maternal and
neonatal health care, training needs of personnel and the access and utilization of
services in the facilities. A team of field enumerators were trained in each state
through UNFPA Technical Assistance and were deployed to the health facilities.
Enumerators were sourced from the state ministry of health and were trained on how
to complete the questionnaire. They were also instructed to ensure that responses to
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the featured questions are obtained from the most senior person in the health facility.
On the average data collection exercises were completed in 2 weeks in most states,
however where poor terrain and long distance were major challenges the exercises
lasted longer. The survey was conducted between October and December 2009.
2.3 LIMITATION OF THE ASSESSMENT
The major challenge encountered during the survey was poor accessibility to some
health care facilities (HCFs). In some cases enumerators had to disembark from the
project vehicle to visit HCFs on foot or through commercial motor-bike. On the other
hand, the selection of HCFs in accordance with the prescribed referral module is
another challenge encountered. Some of the selected HCFs were found to be
dysfunctional and do not meet the requirements of the planned intervention
programme of UNFPA. Such HCFs were dropped and the States were requested to
revise their list and provide substitute.
Data collection tools did not facilitate disaggregation of data by the characteristic of
the HCFs. Data collection on personnel, including issues of training did not reflect
the core UNFPA mandate of gender sensitive data; hence, the information human
resources could be disaggregated by sex.
3 RESULTS OF THE ASSESSMENTS
3.1 BACKGROUND INFORMATION
3.1.1 Designation of Respondents
Data on health facilities were collected from the staff in-charge of the health facilities.
The designations or cadres of respondents to the questionnaire are shown in Table
3.1 and Figure 3.1 below.
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Table 3.1: Frequency Distribution of Respondents by rank and profession
Characteristics Frequency %
Distribution by rank
MO 2 6.9
CHO 6 20.7
CHEW 1 3.4
SCHEW 4 13.8
RN/RM 8 27.6
RN 4 13.8
Matron 1 3.4
Resident Doctor 1 3.4
Health Dispenser 1 3.4
PMO 1 3.4
Total 29 100
Distribution by profession
Community health workers 12 41.4
Nursing and Midwifery 13 44.8
Doctors 4 13.8
Total 29 100
Figure 3.1: Percentage distribution of respondents by profession
The data in Table 3.1 and Figure 3.1 show that 44.8% of the respondents were
Nursing and Midwifery professionals . Another 41.4% of the respondents were
Community health workers professionals while the balance of the respondents
(13.8%) were Medical Doctors. The results suggest that data for the facility
assessment in the State were likely collected from health workers in-charge of the
supported facilities.
3.1.2 Types of supported HCFs
A health care facility (HCF) is any place where medicine is practiced regularly.
Overall, the types of HCFs ranges from small and relatively simple medical clinics
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(such as dispensaries, dental offices, out-patient surgery centres, birthing or delivery
centres, and nursing homes and personal care facilities) to large, complex, and
costly hospitals (General, Specialist, and Teaching and Research). In between the
two extremes are the Comprehensive Health Centres (CHC), Maternity Centres and
Homes, and Primary Health Care Centres (PHCs). In this survey, information was
collected on the types of HCFs supported by UNFPA in the State, and the results of
these are highlighted in Figure 3.2.
Figure 3.2: Percent Distribution of Supported Health Care Facilities by Types
Figure 3.2 shows that the 29 supported health facilities in the State were largely
primary facilities at 72.3%, comprising MCHs (41.4.7%), PHCs (2416%), Clinic (3.4)
and Others (3.4%). Secondary facilities, which is the GH accounted for 22.6%. The
The primary facilities are the closest to the grassroots population in the rural
communities, while the secondary facilities usually represent referral centres to the
primary facilities in the third tier of health care in the country.
3.1.3 Residence status of the supported facilities
Facilities reside or locate in either urban or rural areas. Figure 3.3 present data on
the types of selected health care facilities by location or residential status.
Figure 3.3: Percent Distribution of Respondents by Nature of Residence
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Out of a total of 29 healthcare facilities in the State, 72.4%) were located in the rural
areas; while 27.6%) were located in major urban centres.
3.1.4 Physical Status of the supported HCFs
Interviewers were asked to observe the physical status of the selected HCFs in the
State with respect to general cleanliness, availability of curtains in the
Maternity/Delivery Rooms, and the status of the floor of the labour room. The data
on these indicators of the physical status of selected HCFs are displayed in Table
3.2 and Figures 3.4 to 3.10 below.
Table 3.2: Indicators of the Physical Status of HCFs in the State
S/N Physical status Indicator Freq %
1 General facility status Very clean 10 34.5
Clean 16 55.2
Dirty 2 6.9
Very dirty 0 0
Unstated 1 3.4
Total 29 100
2 Curtains Available 6 20.7
Not available 19 65.5
Unstated 4 13.8
Total 29 100
3 Floor of the maternity/delivery room/ward Very dirty 1 3.4
Dirty 7 24.1
Clean 14 48.3
Very clean 5 17.2
Unstated 2 6.9
Total 29 100
4 Water Available 12 41.4
Not available 15 51.7
Unstated 2 6.9
Total 29 100
5 If available, what is the source of water? Bore Hole 4 33.3
Water mains 3 25.0
Well 4 33.3
Unstated 1 8.3
Total 12 99.9
6 Source of light PHCN 11 37.9
Generator (F) 5 17.3
Generator (NF) 3 10.3
Unstated 10 34.5
Total 29 100
7 Toilet Available 27 93.1
Not available 2 6.9
Total 29 100
8 Bathroom Available 26 89.6
Not available 3 10.4
29 100
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3.1.4.1 General Cleanliness
The data on the general cleanliness of HCFs shown in Table 3.2 and Figure 3.4
reveal that more than half (55.2%) of the supported facilities in the State was clean.
Another 34.5% was very clean. However, the balance of 6.9% was dirty, which may
require renovations to make attractive to clients. Mean while 3.4% did not indicate
status of general cleanliness.
Figure 3.4: General Cleanliness of the Facility
3.1.4.2 Availability of Curtains in the Maternity and Delivery Rooms
Curtains in the maternity or delivery room provide confidence and privacy to women
delivering in HCFs. The status of Curtains in the maternity or delivery rooms are
presented in Table 3.2 above and Figure 3.5 below.
Figure 3.5: Availability of Curtain in the Maternity Ward or Delivery Room
According to the data, the percentage distributions by availability of curtain in the
maternity or delivery room indicates that about one-fifth (20.7%) had Curtians while
Curtains were not available in 65.5%. This suggests that women who attended twothird
of the facilities without curtain in the maternity room did not have the rights to
privacy and comfort during delivery. However, 13.8% of the 29 facilities assessed did
not provide information on the status of curtain in the maternity ward.
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3.1.4.3 Status of the Floor in the Labour Room
Table 3.2 above and Figure 3.6 below present the results on the status of the Floor
in the Labour Room in the State, which are required to make them attractive for
delivery services and to minimize any accidents.
Figure 3.6: Condition of the floor of the Labour Room
The results show that close to half or 48.3% of the supported facilities in the State
were clean. Also, 17.2% of the facilities were very clean. None the less, 24.1% of the
facilities in the State were dirty while 3.4 were very dirty. These findings suggest that
some of the supported in the State required various degrees of renovations to make
facilities more attractive to clients, minimize accidents and to accelerate service
delivery.
3.1.4.4 Availability of Amenities
Amenities are any provisions in the HCFs that enhance its benefits including access,
patronage and performance of service delivery, as well as the sanitary conditions.
Amenities in this context are toilets, water, light, bathroom, waste disposal system,
and sterilization system, wards, and labour or delivery rooms. Figure 3.7 provide
information on the status of amenities in the supported HCFs in the State.
Figure 3.7: Percent Availability of Amenities in supported HCFs in the State
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a) Availability of Toilet and Bathroom amenities
Availability of toilet facility in the HCFs offers safe sanitation facilities and opportunity
for healthy habits for the clients. The results in Figure 3.8 present data on availability
of Toilets and Bathrooms in the Facilities.
Figure 3.8: Percent Availability of Toilets and Bathrooms in supported facilities
The results reveal that 93.1% and 89.6% of the facilities had Toilets and Bathrooms,
respectively within their premises. Information also indicates that 26 of the facilities
(89.7%) that had Toilets also had Bathrooms. Only a facility that had toilet, did not
have any bathroom. However, information on the type and sanitary conditions of the
toilets was not obtained by the survey. The findings suggest that a number of clients
and staff would resort to other methods including bush to defeacate with implications
for environmental sanitation in the HCFs. Lack of toilets within the premises of HCFs
promotes open space or nearby bush defecation, which in turn promotes rapid
growth of fungi and other germs that spread diseases. It is also a source of air
pollution and contamination of open water sources.
b) Availability of Safe Water Sources
Access to safe water sources by 2015 is one of the indicators of the MDGs 7 -
ensure environmental sustainability. Inadequate access to safe drinking water leads
to widespread water borne diseases and is a major cause of death in many
countries. Poor sanitation, water and hygiene have many other serious
repercussions. Staff are denied the right to good healthy working environment
because their HCFs lack sanitation facilities. Staff also spend parts of their working
hour fetching water for sanitary purposes in the HCFs. Hence, availability of water in
HCFs enhances healthy, effective and efficient medical practices that guarantee
good health of clients and other stakeholders. The study investigated the availability
and sources of safe water in the selected HCFs. Table 3.2 and Figures 3.7 and 3.9
present the data on availability and source of water in the HCFs.
17

Figure 3.9: Main source of water within the premises of supported facilities
The results presented in the Table 3.2 and Figure 3.7 indicates that water was
available in less than half of the supported facilities (41.4%) in the State. According
to Figure 3.9, 33.3% of these facilities relied on Borehole for water, Another 33.3%
obtained water from Well, while 25% obtained water from Water Main. Borehole and
Water main are acclaimed safe sources. However, Rivers and Well are acclaimed
unhygienic sources of water. However, 8.3% of the facilities did not state its source
of water supply.
c) Main Sources of Light
Sources of light include electricity, lambs, gas, lanterns, candles torches and
generator sets. Some of these sources, especially electricity is used to operate
equipment and apparatuses in HCFs such as computers, television, washers; as well
as to light, heat, and cool buildings, cook food, boil water, wash clothes, provide
entertainment, and power transportation system. Table 3.2 and Figure 3.7 indicate
that 65.5% of the 29 assessed facilities had light.
Figure 3.10: Sources of Light in the supported Facilities
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However, as shown in Table 3.2 and Figure 3.10; 37.9% of the 29 supported HCFs
had supply of electricity from both PHCN, 17.3% of these supported HCFs depend
on light from functional Generators, while 10.3% obtained electricity from
dysfunctional Generator. More than one-third of the facilities at 34.5% did not
indicate their source of light at all.
3.1.5 Methods of Waste Management
Waste disposal is the process of getting rid of unwanted, broken, worn out,
contaminated, used or spoiled equipment and materials in an orderly and regulated
fashion; with a view to reduce their effect on health, the environment, aesthetics;
and/or to recover resources. Health-care activities generate wastes that may lead to
adverse health effects. These wastes include infectious waste (15% to 25% of total
health-care waste) among which are sharps waste – needles, syringes and blades
(1%), body part waste (1%), chemical or pharmaceutical waste – laboratory solvents,
expired drugs and cleaning chemicals (3%), and radioactive and cytotoxic waste or
broken thermometers (less than 1%).
Sharps waste, although produced in small quantities, is highly infectious. If poorly
managed, they expose healthcare workers, waste handlers and the community to
infections. Contaminated needles and syringes represent a particular threat and may
be scavenged from waste areas and dump sites and be reused with serious health
implications. The supported HCFs in the State generate and dispose of waste in
different ways, however data was not collected on the types and management of
waste for possible strengthen, as part of baseline for tracking improvement waste
management.
3.1.6 Common RH problems reported at Facilities
The most frequency occurring RH problems reported by the supported facilities were
Early marriage, Teenage pregnancy, Miscarriages/induced abortions, VVF/RVF,
FGC and STIs/HIV&AIDS (Table 3.3).
Table 3.3: Common RH problems in the State
RH problem Frequency %
FGC 1 3.4
Early marriage 24 82.8
Teenage pregnancy 23 79.3
Miscarriages/Induced abortions 7 24.1
VVF/RVF 1 3.4
STI/HIV&AIDS 1 3.4
3.2 HUMAN RESOURCES IN THE SUPPORTED FACILITIES
3.2.1 Availability of health workers
Though Nigeria has the largest number of health human resources in Africa, health
personnel are unevenly spread across the six geopolitical zones and between the
rural and urban areas of the country. There is also uneven distribution of health
workers between the few secondary HCFs that provide CEmONC services, thereby
creating acute shortage of health personnel in the primary healthcare facilities that
19

provide BEmONC services. The other issue is the preponderance of unskilled health
workers in the healthcare sector. Yet, availability of adequate health worker and right
mix are critical to the delivery of quality reproductive health services in the health
facilities. On the basis of this, the study examines the level of health human
resources in the selected HCFs in the State, and this section present and discusses
data on skilled (doctors, nurses and midwives), unskilled (CHOs, CHEWS and
Attendants) and other categories of health workers, including issues of trainings.
Table 3.4 displays the frequency distribution of health workers in the supported
facilities by categories and type of HCFs. It also shows the rural-urban dichotomy in
human resource distribution.
Overall, the results in Table 3.4 reveal that the 29 supported facilities in the State
had a total 851 health workers. Out of this total, 555 (65.2%) were in rural facilities
compared to 292 (34.8%) work in urban facilities. The distribution by the types of
facilities indicates that 416 (48.9%) worked in GHs, while balance of 435 (51.1%)
that provided healthcare services in the primary types of facilities. In terms of the
distribution by the types of health workers, Ward Assistants with 375 (44.1%)
recorded the highest, distantly followed by Compound Labourers with 76 (8.9%).
Nurse Anesthetists recorded the least with 1 (0.1%).
20

Table 3.4: Frequency distribution of health workers by types of health care facilities and nature of residence
Staff Strengths by categories and types
Residence
Facility type
MO PhA RNM RN RM NA CHO CHEW JCHEW MLT MLA WA WM Lab HE SW Oth
Tot %
Rural/urban MCH 1 0 11 6 11 1 3 31 34 6 4 107 18 27 6 4 8 278 32.7
PHC 1 0 3 4 2 0 8 16 15 1 6 40 13 10 3 3 5 130 15.3
GH 8 2 28 40 2 0 1 5 7 12 11 218 35 36 1 8 2 416 48.9
Clinic 0 0 0 0 0 0 0 1 2 0 0 9 1 2 0 0 0 15 1.8
Others 0 0 1 1 0 0 0 0 2 0 1 1 1 1 1 1 2 12 1.4
Total 10 2 43 51 15 1 12 53 60 19 22 375 68 76 11 16 17 851 100.0
% 1.2 0.2 5.1 6.0 1.8 0.1 1.4 6.2 7.1 2.2 2.6 44.1 8.0 8.9 1.3 1.9 2 100
Rural MCH 0 0 5 4 5 1 3 22 9 3 2 61 13 13 5 1 5 152 17.9
PHC 1 0 3 4 1 0 7 13 13 1 4 20 11 8 1 2 4 93 10.9
GH 5 1 20 26 2 0 1 5 6 6 8 150 22 20 1 8 2 283 33.3
Clinic 0 0 0 0 0 0 0 1 2 0 0 9 1 2 0 0 0 15 1.8
Others 0 0 1 1 0 0 0 0 2 0 1 1 1 1 1 1 2 12 1.4
Sub‐Total 6 1 29 35 8 1 11 41 32 10 15 241 48 44 8 12 13 555 65.2
% 0.7 0.1 3.4 4.1 0.9 0.1 1.3 4.8 3.8 1.2 1.8 28.3 5.6 5.2 0.9 1.4 1.5 65.2
Urban MCH 1 0 6 2 6 0 0 9 25 3 2 46 5 14 1 3 3 126 14.8
PHC 0 0 0 0 1 0 1 3 2 0 2 20 2 2 2 1 1 37 4.3
GH 3 1 8 14 0 0 0 0 1 6 3 68 13 16 0 0 0 133 15.6
Clinic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0
Others 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0
Sub‐Total 4 1 14 16 7 0 1 12 28 9 7 134 20 32 3 4 4 296 34.8
% 0.5 0.1 1.6 1.9 0.8 0 0.1 1.4 3.3 1.1 0.8 15.7 2.4 3.8 0.4 0.5 0.5 34.8
21

3.2.1.1 Availability and deployment of skilled health workers
Medical doctors and Nursing and Midwifery professionals were regarded as skilled
health workers. Table 3.5 shows the availability and deployment of skilled health
workers in the supported facilities. Mean while, Figures 3.11a and 3.11b summarise
the distribution by types of facilities and residence respectively.
Table 3.5: Frequency distribution of skilled health workers by types of health
care facilities and nature of residence
Facility Staff Strengths by categories and types
type MO RNM RN RM NA Tot %
MCH 1 11 6 11 1 30 25
PHC 1 3 4 2 0 10 8.3
GH 8 28 40 2 0 78 65
Clinic 0 0 0 0 0 0 0
Others 0 1 1 0 0 2 1.7
Total 10 43 51 15 1 120 100
% 8.3 35.8 42.5 12.5 0.8 100.0
MCH 0 5 4 5 1 15 12.5
PHC 1 3 4 1 0 9 7.5
GH 5 20 26 2 0 53 44.2
Clinic 0 0 0 0 0 0 0
Others 0 1 1 0 0 2 1.7
Sub-Total 6 29 35 8 1 79 65.8
% 60 67.4 68.6 53.3 100.0 65.8
MCH 1 6 2 6 0 15 12.5
PHC 0 0 0 1 0 1 0.8
GH 3 8 14 0 0 25 20.8
Clinic 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0
Sub-Total 4 14 16 7 0 41 34.2
% 40 32.6 31.4 46.7 0.0 34.2
Figure 3.11a: Frequency distribution of skills workers by types of facility
22

Figure 3.11b: Percent distribution of skills workers by residence
There were 120 skilled health workers in the supported facilities in the State, out of
which RM with 51 accounted for highest proportion of 42.5%. This was followed by
RNM with 43 or 35%. Nurse Anesthetist accounted for the least with 1 (0.8%).
However, there were only 10 Medical Officers (8.3%). In the mean time, 78 of the
skilled health workers (65%) worked in secondary facilities while the balance of 42
(35%) were available in the primary facilities. There were no skilled health workers in
the Clinic. Also, 79 skilled health workers (65.8%) were available in the rural areas
compared to 41 (34.5%) in the urban areas. The following sub-section provide detail
analysis of the types various types of skilled health workers.
a) Availability Medical Doctors in the supported HCFs
For the purpose of this health facility survey, medical doctors were categorised into
three, namely medical officers, OG specialists and other specialists. A medical
officer applies medical knowledge to properly diagnose a patient's ailment,
prescribes medication for a patient’s treatment, provide healthier lifestyle
recommendations, and/or refers the patient to a doctor who specializes in a specific
areas such as an OG specialist, or other specialists (Paediatrician, Internist, or
Surgeon), if a patient’s health concerns are beyond a his scope of practice. An
Obstetric Gynaecologist (OG) is a medical doctor who has specialized training in
issues of a woman’s reproductive system (ovaries, uterus, vagina) and urinary tract
health, such as stress incontinence. OG specialists are trained to evaluate,
recognize and treat potential disease of the reproductive system, and to surgically to
perform surgeries like hysterectomies, (removal of the uterus). Data on the visibility
of Medical Officers, OG specialist and other specialists in the selected HCFs in the
State are shown in Table 3.6 and Figures 3.12a and 3.12b.
23

Table 3.6: Frequency distribution of Doctors by types of health care facilities
and nature of residence
Staff Strengths by
Facility type categories and types
%
Residence
Medical Officers Total
Rural/urban MCH 1 1 10
PHC 1 1 10
GH 8 8 80
Clinic 0 0 0
Others 0 0 0
Total 10 10 100
% 100 100
Rural MCH 0 0 0
PHC 1 1 10
GH 5 5 50
Clinic 0 0 0
Others 0 0 0
Sub-Total 6 6 60
% 60 60
Urban MCH 1 1 10
PHC 0 0 0
GH 3 3 30
Clinic 0 0 0
Others 0 0 0
Sub-Total 4 4 40
% 40 40
Figure 3.12a: Frequency distribution of Doctors by types of health care
facilities
24

Figure 3.12b: Percent distribution of Doctors by nature of residence
According to the results, there were a total 10 medical doctors providing healthcare
services in the supported facilities; and all of the 10 were medical officers. Out of this
number, 8 MOs (80%) worked in the secondary facilities, while only 2 (20%)
provided healthcare services in the Primary Facilities. There were, however, no MOs
in the Clinic and other categories of the primary facilities. Six MOs (60%) provided
healthcare services in the rural areas as against 4 MOs (40%) who worked in the
urban areas. These results suggest that there no any Specialist Doctors (O&G) and
Other Specialist Doctors to support CEmONC services, including Pediatrics issues in
the supported facilities of the State. Even the MOs were not available in all the
facilities The non-availability of medical officers in the Primary Facilities places
constraints on the ability of these facilities to provide BEmONC services, which imply
the Primary Facilities should be strengthened with strong referral system to facilitate
referral of clients to the GHs and other secondary facilities for an optimal
performance of the health sector in the State. Similarly, the non-availability of
Specialist Doctors (O&G) and other Specialist Doctors in the Secondary Facilities
places constraints on the ability of these facilities to provide CEmONC services,
which also imply the secondary facilities should be strengthened with strong referral
system to facilitate referral of clients to the tertiary facilities or any other secondary
facilities for an optimal performance of the health sector in the State.
b) Availability of Nursing and Midwifery professionals
Registered Nurse/Midwives, registered Nurse, registered Midwife and registered
Nurse Anesthetists constitute the Nursing and Midwifery professionals. Table 3.7
and Figures 3.13a and 3.13b present the data on these Nursing and Midwifery
professionals.
The distribution of the Nursing and Midwifery professionals show that 110 nursing
and Midwifery professionals were available in the supported facilities. Registered
Nurses accounted for 51 or 46.4%, followed by RNM who accounted for 39.1%. The
others were RM with 15 (13.6%) and RNA with 1 (0.9%). Of this number, 70 (63.6%)
were available in secondary facilities compared to 40 (36.4%) in primary facilities.
Also, out of the total 73 (66.4%) were available in the rural areas as against 37
(33.6%) in the urban areas.
25

Table 3.7: Frequency distribution of Nursing and Midwifery staff by types of
health care facilities and nature of residence
Staff Strengths by categories
Residence Facility type and types
RNM RN RM NA Total %
Rural/urban MCH 11 6 11 1 29 26.4
PHC 3 4 2 0 9 8.2
GH 28 40 2 0 70 63.6
Clinic 0 0 0 0 0 0.0
Others 1 1 0 0 2 1.8
Total 43 51 15 1 110 100.0
% 39.1 46.4 13.6 0.9 100.0
Rural MCH 5 4 5 1 15 13.6
PHC 3 4 1 0 8 7.3
GH 20 26 2 0 48 43.6
Clinic 0 0 0 0 0 0.0
Others 1 1 0 0 2 1.8
Sub-Total 29 35 8 1 73 66.4
% 67.4 68.6 53.3 100.0 66.4
Urban MCH 6 2 6 0 14 12.7
PHC 0 0 1 0 1 0.9
GH 8 14 0 0 22 20.0
Clinic 0 0 0 0 0 0.0
Others 0 0 0 0 0 0.0
Sub-Total 14 16 7 0 37 33.6
% 32.6 31.4 46.7 0.0 33.6
Figure 3.13a: Frequency distribution of Nursing and Midwifery staff by types of
health care facilities
26

Figure 3.13b: Percent distribution of Nursing and Midwifery staff by nature of
residence
i) Registered Nurses and Midwives
Registered Nurses and Midwives (RNM) are popularly referred to double
qualifications. The visibility of RNM in facilities ensures safe births and averting
maternal and newborn deaths and disabilities. RNM also play a central role in
providing FP and counseling, and in preventing HIV transmission from mother to
child. Investments in strengthening the RNM workforce skills with life saving
competencies; and the adequate policies surrounding their retention, deployment
and distribution; can help to prevent some 80% of maternal deaths. Hence, UNFPA
is one of the donours that invests in midwifery skills to accelerate progress towards
MDGs 4 and 5. The number of registered Nurses and Midwives (RNM) were
requested through the questionnaire and the responses from the supported facilities
are presented in Table 3.7 and Figures 3.13a and 3.13b.
The information indicate there were a total of 43 registered Nurses and Midwives,
out of which 28 (65.1%) were available in the secondary facilities as against 15
(34.9) in the primary facilities. Further, 29 (67.4%) were available in rural areas
compared to 14 (32.6%) in urban areas. Meanwhile, RNM were not available in
some primary facilities, especially the Clincs. The non-availability of RNMs in some
facilities places constraints on the ability of these facilities to handle pregnancy
related complications, which also imply that there should be a strong referral system
for unskilled health workers to refer clients to primary and secondary facilities, where
Doctors and RNMs were available.
ii) Registered Nurse
Registered Nurses (RN) provide patient care, educate patients on their disease and
how to live a healthy lifestyle, they monitor the patients’ illness and record and
monitor their responses to treatment and medication. Table 3.7 and Figures 3.13a
and 3.13b present the data on the registered Nurses that were available in the
supported facilities. According to the results, 78.4% of the 51 registered Nurses were
deployed to GH. Only 11 (21.6%) were available in the primary facilities. And 35
(68.6%) were in rural facilities compared to 16 31.4%) in urban facilities. The Clinic,
which a primary facility did not have any RN. None the less, the existing RNs should
27

e strengthened with midwifery skills and life saving competencies to accelerate
progress toward MDGs 4 and 5.
iii) Registered Midwives
A registered midwife (RM) is a health care professional who provides primary care to
women during pregnancy, labour and birth, including conducting normal vaginal
deliveries and providing care to mothers and babies during the first 6 weeks
postpartum. Midwives provide safe, personalized, research-based care. They attend
births in hospital or home according to the woman's choice and professional
protocols and are on-call and available to their clients 24 hours a day during the
course of care. The study also examined the visibility of registered midwives in the
health facilities. The distribution of registered Midwives available in the supported
facilities is presented below in Table 3.7 and Figures 3.13a and 3.13b.
These results show that only 2 (13.3%) of the 15 RMs were in the GHs. The balance
of 13 (86.3%) were deployed to the primary facilities. The the distribution by
residence indicate that the 8 RM (53.3%) worked in the rural areas compared to 7
(46.7%) in the urban areas. These results suggest that registered Midwives were
very scarce in most of the UNFPA supported helath facilities, especially at the
Clininc and oth category of primary facilities. The attention of policy makers,
planners and donours should drawn to the criticak role that midwives play in
facilities, and the urgent need to invest midwives and others with midwifery skills to
accelerate progress towards MDGs 4 and 5.
iv) Registered Nurse Anesthetist
A registered Nurse Anaesthetist (RNA) specialises in the provision of anaesthesia
care to a patient from pre-operation procedures through surgery and into recovery,
ensuring that the patient is as safe and comfortable. They administer anaesthesia to
patients having surgery or other procedures and/or work alongside
anaesthesiologists, who are trained as physicians. The distribution of registered
Nurse Anesthetist available in the UNFPA supported facilities is presented below in
Table 3.7 and Figure 3.13a and 3.13b. The results depict that only one registered
Nurse Anesthetists was available in one of the primary facilities in the rural area.
This suggest that most of the supported facilities in the State did not have any
registered Nurse Anesthetists to support Physicians in performing surgeries. These
findings imply that Nurse Anaesthsist are very rare in the UNFPA supported facilities,
which has negative implications for effective implementation of EmONC services.
Data was however not collected on visibility of other types of Nursing such as
Obstetrics Nurse who takes care of the mother before and during labour, and provide
neonatal care to unhealthy newborn babies.
3.2.1.2 Unskilled Health Workers
The unskilled health workers are the community health workers (which include
CHOs, CHEWs and JCHEWs in Nigeria) and Ward Attendants. First, community
health workers, also called "Village Health Workers” (VHWs), or ‘lay health advisors’
are members of a community who are chosen by community members to provide
basic health and medical care to their community. In many developing countries,
including Nigeria, there are critical shortages of professional health workers. Current
medical and nursing schools cannot train enough workers to keep up with internal
28

and external emigration, deaths from AIDS and other diseases, low worker
productivity, and population growth. CHWs are therefore given a limited amount of
training to provide essential, safe, and highly effective primary health care services
to the population. Programmes involving CHWs in China, Brazil and Iran have
demonstrated that utilizing such workers can help improve health outcomes for large
populations in under-served regions. “Task shifting” of primary care functions from
professional health workers to CHWs is considered to be a means to improving the
health of millions at reasonable cost. But, experience in Nigeria has also shown that
this task shifting is a drag on efforts to accelerate progress towards MDGs 4 & 5.
Secondly, ward attendant or assistant supports skilled health workers in the health
facilities in providing basic care for patients. The job requires ability to lift patients,
great people skills, a sense of humour and tolerance for cleanup and care of patients
who cannot fully care for themselves. Most nursing assistants, undergo training
through on-the-job experience or short-term programmes offered by some schools,
colleges and organizations like the Red Cross. Table 3.8 present the data on the
number of these unskilled health workers that were available in the supported
facilities. The summary of these data are shown in Figures 3.14a and 3.14b.
Table 3.8: Frequency distribution of unskilled health workers by types of health care
facilities and nature of residence
Unskilled Staff Strengths by
Residence
categories and types
Facility type CHO CHEW JCHEW WA Total %
Rural/urban MCH 3 31 34 107 175 35
PHC 8 16 15 40 79 15.8
GH 1 5 7 218 231 46.2
Clinic 0 1 2 9 12 2.4
Others 0 0 2 1 3 0.6
Total 12 53 60 375 500 100
% 2.4 10.6 12 75 100
Rural MCH 3 22 9 61 95 19
PHC 7 13 13 20 53 10.6
GH 1 5 6 150 162 32.4
Clinic 0 1 2 9 12 2.4
Others 0 0 2 1 3 0.6
Sub-Total 11 41 32 241 325 65
% 91.7 77.4 53.3 64.3 65.0
Urban MCH 0 9 25 46 80 16
PHC 1 3 2 20 26 5.2
GH 0 0 1 68 69 13.8
Clinic 0 0 0 0 0 0
Others 0 0 0 0 0 0
Sub-Total 1 12 28 134 175 35
% 8.3 22.6 46.7 35.7 35.0
29

Figure 3.14a: Frequency distribution of unskilled health workers by types of health
care facilities and nature of residence
Figure 3.14b: Percent distribution of unskilled health workers by residence
According to the results in Table 3.8, 500 unskilled health workers were available in
the supported facilities in the Staff. Of the number, the highest number of 375 (75%)
were Ward Attendants and the least number of 12 (2.4%) was CHOs. JCHEW and
CHEW accounted for 60 (12%) and 53(10.6%), respectively. The distribution of
unskilled health workers by the types of facilities indicate that 231 (46.2%) were in
secondary facilities, while 269 (53.8%) were in primary facilities. The distribution of
unskilled health were also uneven between rural facilities with 325 (65% and the
urban facilities with 175 (35%).
Specific analysis of data by the types of unskilled health workers depict 218 958.1%)
of the 375 Ward Attendants were available in secondary facilities compared to 157
(41.9%) in primary facilities; and 241 (64.3%) were in rural areas while 134 (38.7%)
were in urban areas.
30

Among the 60 JCHEW in the supported facilities, only 7 (11.7%) were in secondary
facilities while the balance of 53 (88.3% were in primary facilities. Mean while, 32
(53.3%) were in rural areas as against 28 (46.7%) in urban areas.
Five (9.4%) of 53 CHEWs were available in secondary facilities while 48 (90.6%)
were in primary facilities. But, 41 (77.4%) were in rural areas comapred to 12
(22.6%) in urban areas. As for the 12 available CHOs, only 1 (8.3%) was in a
secondary facilities while thev remaining 11 (91.7%) was in primary facilities. The
residential distribution of CHOs was in favour of rural areas with 11 (91.7%)
compared to 1 (8.3%) in urban areas.
Over all, the distribution of the types of unskilled health workers by types facilities
favoured primary facilities. Similarly, the distribution of unskilled health workers by
residence favoured rural areas. There is therefore the need build the capacity of
some types of unskilled health workers, especially the CHEW with MLSS training to
provide some basic EmONC services and enhance the achievement of MDGs 4 and
5.
3.2.1.3 Other Health Workers in the supported HCFs
a) Pharmacists, Pharmacy Technicians and Pharmacy Assistants in the
supported facilities
The Drug and Pharmacies Regulatory Act stipulates that no person other than a
pharmacist or an intern or a registered pharmacy student acting under the
supervision of a pharmacist who is physically present, shall compound, dispense or
sell any drug in a pharmacy. For this purpose, pharmacists are specialists in the
knowledge of medications, and an important medical worker in the health facility who
helps physicians, dentists and veterinarians by dispensing appropriate medications
to patients. However, pharmacy assistants or pharmacy aides work in pharmacies
stocking shelves, answering phones, completing administrative duties, and assist
pharmacy technicians, while pharmacy technicians prepare medication, fill
prescriptions and maintain medical records, deliver medication to patients, and
maintain medical supplies for each patient. In many facilities, the terms ‘pharmacy
assistant’ and 'pharmacy technician' are used interchangeably, so that titles and
responsibilities may overlap. Table 3.9 below shows the distribution of Pharmacists,
Pharmacy Technicians and Pharmacy Assistants in the supported facilities.
31

Table 3.9: Frequency distribution of pharmaceutical health workers by types of
health care facilities and nature of residence
Pharmaceutical health
workers by Types
Facility type Pharmacy Assistants Total %
MCH 0 0 0
PHC 0 0 0
GH 2 2 100
Clinic 0 0 0
Others 0 0 0
Total 2 2 100
% 100 100
MCH 0 0 0
PHC 0 0 0
GH 1 1 50
Clinic 0 0 0
Others 0 0 0
Sub-Total 1 1 50
% 50 50
MCH 0 0 0
PHC 0 0 0
GH 1 1 50
Clinic 0 0 0
Others 0 0 0
Sub-Total 1 1 50
% 50 50
The data in Table 3.9 indicate that only 2 Pharmacy Assistants were available in the
GHs, and one each was available in the rural and urban areas. No Pharmacist was
available in any of the supported facilities. These findings suggest there is an acute
dearth of Pharmacists and Pharmacy Assistants in the supported facilities in the
State and the need for programme intervention to advocate for recruitment of
pharmaceutical workers in the supported facilities. There is the need to train the two
available Pharmacy Assistants to helps physicians, dentists and veterinarians by
dispensing appropriate medications to patients.
b) Medical Laboratory Technologists and Medical Laboratory Assistants in
the supported Facilities
Medical laboratory technologist (MLT) and Medical laboratory assistants (MLA)
prepare and process laboratory tests in a wide variety of areas; blood banking,
chemistry, hematology, immunology, and microbiology, etc in any facility. The data in
table 3.10 below reveal that there are few MLT and MLA. Figures 3.15a and 3.15b
depict the summary of the distribution of laboratory staff by the types and facilities
and residence, respectively.
32

Table 3.10: Frequency distribution of laboratory health workers by types of
healthcare facilities and nature of residence
Residence Facility type MLT MLA Total %
Rural/urban MCH 6 4 10 24.4
PHC 1 6 7 17.1
GH 12 11 23 56.1
Clinic 0 0 0 0.0
Others 0 1 1 2.4
Total 19 22 41 100.0
% 46.3 53.7 100.0
Rural MCH 3 2 5 12.2
PHC 1 4 5 12.2
GH 6 8 14 34.1
Clinic 0 0 0 0.0
Others 0 1 1 2.4
Sub-Total 10 15 25 61.0
% Rural 52.6 68.2 61.0
Urban MCH 3 2 5 12.2
PHC 0 2 2 4.9
GH 6 3 9 22.0
Clinic 0 0 0 0.0
Others 0 0 0 0.0
Sub-Total 9 7 16 39.0
% Urban 47.4 31.8 39.0
Figure 3.15a: Frequency distribution of laboratory health workers by types of health
care facilities
33

Figure 3.15b: Percent distribution of laboratory health workers by residence
The data on the number MLT and MLA in supported facilities revealed that there
were a total of 41 medical laboratory personnel in the State, more than half of whom
at 53.7% were MLT and the balance of 46.3% were MLA. Also, more than half of the
laboratory staff at 56.1% worked in the GHs and 43.9% worked in primary facilities.
Further, 61.0% of the laboratory staff at 66.9% was available in rural facilities as
against 39.0% that were in the urban facilities. Furthermore, there were more MLT at
52.6% and MLA at 68.2% worked in the rural areas as against 47.4% and 31.8%
respectively who worked in the urban facilities. More than half of MLT at 12 (63.1%)
out of 12 and half of the MLA at 11 (50.0%) out of 22 worked in the GHs; compared
with 37.8 of MLT and 50% of MLAs that worked in the Primary facilities. In view of
the fact that most the supported facilities in the State were located in the rural areas,
these findings suggest that MLTs and MLAs were also very scarce in most of the
rural health facilities in general the PHCs in particular like their pharmaceutical staff.
c) Health educators, social workers, labourers, watchmen and others
Health educators work to encourage healthy lifestyles and wellness by educating
individuals and communities about behaviors that can prevent diseases, injuries, and
other health problems. Within health facilities, health educators work one-on-one
with patients and their families to educate them on their diagnosis and how that may
change or affect their lifestyle. In doing this, health educators explain the necessary
procedures or surgeries as well as how patients will need to alter their lifestyles to
manage their illness or return to full health. They also direct patients to outside
resources, such as support groups, home health agencies, or social services. Often,
health educators work closely with other health workers to create educational
programmes or materials, and in some cases, to train facility staff on how to better
interact with patients.
On the other hand, the primary role of social workers in the health facilities is to
assess the needs (based on such criteria as your educational level, support from
friends and family, your financial situation and living arrangements) and then to help
clients and the facilities to take care of those needs. The information collected by
the social worker can help inform the healthcare providers and clients about how
best to treat illnesses, manage diseases, how to best interact with clients, and even
help weave through the healthcare system and leverage local resources to manage
34

day-to-day life. Hence, social workers offer a broad range of services in health
facilities, including emotional support, referrals for community resources, counseling
services (perform one-on-one counseling with a variety of clients), advocate for a
services/patient, and work with community groups to develop resources that will aid
medical patients and other constituencies, including people with hard-to-diagnose
symptoms. The distribution of Health Educators, Social Workers, Compound
Labourers, Watchmen and Other workers in the supported facilities is shown Table
3.11 below. On the other hand, Figures 3.16a and 3.16b summarise the distribution
of other types of health workers by facilities and residence, respectively.
Table 3.11: Frequency distribution of other health workers by types of health care
facilities and nature of residence
Other types of health workers
Residence Facility type Watchmen Labourer HE SW Others Total %
Rural/urban MCH 18 27 6 4 8 63 33.5
PHC 13 10 3 3 5 34 18.1
GH 35 36 1 8 2 82 43.6
Clinic 1 2 0 0 0 3 1.6
Others 1 1 1 1 2 6 3.2
Total 68 76 11 16 17 188 100.0
% 36.2 40.4 5.9 8.5 9.0 100.0
Rural MCH 13 13 5 1 5 37 19.7
PHC 11 8 1 2 4 26 13.8
GH 22 20 1 8 2 53 28.2
Clinic 1 2 0 0 0 3 1.6
Others 1 1 1 1 2 6 3.2
Sub-Total 48 44 8 12 13 125 66.5
% Rural 70.6 57.9 72.7 75.0 76.5 66.5
Urban MCH 5 14 1 3 3 26 13.8
PHC 2 2 2 1 1 8 4.3
GH 13 16 0 0 0 29 15.4
Clinic 0 0 0 0 0 0 0.0
Others 0 0 0 0 0 0 0.0
Sub-Total 20 32 3 4 4 63 33.5
% Urban 29.4 42.1 27.3 25.0 23.5 33.5
35

Figure 3.16a: Distribution of other types of health workers by the types of
facilities
Figure 3.16b: Distribution of other types of health workers by residence
The information in Table 3.11 reveal that there were a total of 188 other types of
health workers in the 29 supported facilities, out of whom 82 (43.6%) were available
in secondary facilities compared to 106 (56.4%) in primary facilities. The total figure
was also unevenly distributed among the rural areas with 125 (66.5%) and urban
areas at 63 (33.4%). Compound labourers accounted for 76 (40.4%); followed by
Watchmen with 68 (36.2%). Health Educators reported the least number of 11
(5.9%). However, SW accounted for 16 (8.5%) and others recorded 17 (9.0%).
The data in Table 3.11 and Figures 3.16a and 3.16b also depict that the 11 Health
Educators available in the facilities were unevenly distributed between secondary
facilities with 1 (9.1%) and primary facilities at 10 (90.1%); and most of the Health
Educators (72.7%) were located in the rural areas of the State while only 3 HE
(27.3%) worked an urban facility. The results also show that the 16 Social Workers
were evenly distributed between primary facilities, but unevenly distributed between
rural areas with most of them 12 (75%) and the urban areas with 4 (25%).
36

Further, out of 76 Compound Labourers, 36 (47.4%) worked in the in the GHs and
40 (52.6%0 worked in primary facilities to ensure compound sanitation. But 44
Labourers (57.4%) worked in rural facilities while 32 (43.6%) worked in the urban
areas. Availability of compound labourers has implication for environmental
sanitation of the facilities.
Among the 68 Watchmen, 35 (51.5%) were available in the GHs, while 33 (48.5%)
worked in the primary types of facilities. Fourty-eight (70.6%) of the Watchmen
worked in the rural areas, as against 20 (29.4% that were available in urban areas.
Furthermore, out of 17 other types of workers, which included Drivers in the
supported facilities in the State; 2 (11.8%) worked in secondary types of facility while
the balance of 15 (88.2%) were available in the primary facilities. Also, 13 (76.5%) of
other types of workers were in rural facilities compared to 4 (23.5%) in the urban
areas. Availability of Drivers has implications for functional means of transport.
Hence, there is the need to validate findings on the other types workers, which were
largely Drivers with the data on availability of functional means of transport.
Over all, there were uneven distributions of health workers between the rural and
urban areas, as well as between the various types of health facilities. There were
generally low levels of human resources in most of the supported facilities, and the
situations in the Primary Facilities were more critical, especially skilled health
workers. It is expected that the Federal Government Programme that recently
recruited about 6,000 midwives and deployed them to 600 rural local governments
areas and the proposed mandatory posting of house doctor to rural areas will help to
alleviate the challenges of the low human resources and capacities in public health
facilities in the supported state and to address the capacity gap in the primary
healthcare sector of the State. The availability of medical personnel in the primary
health sector of the State is critical to the successful delivery of UNFPA mandate in
the RHR. UNFPA will need to intensify advocacy efforts to strengthen the health
sector and to recruit and train more health workers especially in the public primary
and secondary health care facilities of the State, if the health system will be
strengthened and enhanced.
3.3 TYPES OF TRAINING RECEIVED BY HEALTH WORKERS
Central to UNFPA programme delivery is the capacity building of health workers.
Factors such as the shortage of health workers and the need to scale up service
delivery have critical impact on the IPs’ capacity to recruit and trained health care
workers to deliver quality health services. Therefore, the facility assessment included
questions to track the types of training attended or received by health workers in the
supported facilities of the State. However, data on the number of staff trained by the
type of training indicate that no health worker was trained in the State.
3.4 TYPES OF HEALTHCARE SERVICES PROVIDED
Table 3.12 shows the services provided by facility types and how frequently the
services were provided.
37

Table 3.12: Percentage Distribution of the Types of Services by the Types of supported
Facilities and how frequently the services were provided
MCH PHC GH Clinic Others
Ave How often Freq
provided
Type of Services offered 12 7 8 1 1
ANC 91.7 71.4 100 100 100 89.7
PNC 83.3 71.4 75 100 100 79.3
Daily 1
Twice a week 1
Weekly 23
On demand 1
Weekly 13
Monthly 2
On demand 8
Deliveries 91.7 71.4 100 100 100 89.7 NA NA
Daily
2
Child Welfare
83.3 71.4 75 100 100 79.3
FP 75 57.1 87.5 100 100 75.9
HIV Counselling 41.7 0 75 100 0 41.4
Weekly 17
Monthly
`2
On demand 2
Daily 1
Weekly 5
Monthly 1
On demand 15
Daily 1
Weekly 3
On demand 8
HIV Testing 16.7 0 100 0 0 34.5 NA NA
Weekly 19
Immunisation
Monthly 2
100 85.7 62.5 100 100 86.2 On demand 4
Syndromic Mgt of STIs 83.3 57.1 87.5 0 100 75.9 NA
Fistula Repairs 0 0 12.5 0 0 3.6 NA
Treatment of Minor Ailment 100 85.7 100 100 100 96.4 NA
3 x a week 1
Home Visits
2 x a week 1
Weekly 8
2 x a month 1
Monthly 7
100 71.4 37.5 100 100 75.9 On demand 4
Referral Services 100 85.7 100 100 100 96.5 NA NA
Community Outreach 50 42.9 0 100 100 39.3
weekly 1
Monthly 9
3.3.1 ANC, Delivery Care and PNC Services
Table 3.12 and Figure 3.17 present the data on ANC, delivery care and PNC
services by the types of supported facilities in the State.
38

Figure 3.17: Percentage of the Types of facilities that offered ANC, Delivery
care and PNC services
Table 3.12 and Figure 3.17 show that on the average, 89.7% each of the supported
facilities in the State offered ANC services and Delivery care services; while 79.3%
of them provided PNC services. These results suggest that there were gaps between
attendance for ANC and Delivery care services, and those for PNC services. The
dichotomy between in the provision of ANC and delivery care and those of PNC
services by the types of supported facilities. The proportion of supported facilities
that provided PNC services was lower than the percentages of facilities that provided
delivery care and ANC services by 10.3%. This suggest that there were facilities that
offered ANC and delivery care services, but did not offered PNC services; which
depict a break in the continuum of maternal health care. It is also means that most
PNC services were probably those associated with post-delivery complications,
which could explain why higher percentages of MCH and GHs offered PNC services.
The results in Table 3.12 also reveal that ANC services were provided on weekly
basis in 23 facilities (82.1%); PNC services were provided on demand in 13 facilities
(46.4%) and on weekly basis in 8 supported facilities (28.6%). The results suggest
that maternal health appears as one of the primary focus of all supported health
facilities in the State. The results on the provision of ANC, delivery care and PNC
services also offers great opportunities and potentials for the integration of
RH/FP/HIV services.
3.4.2 Child Welfare and Immunization Services
The study shows that the provision of child welfare services in the supported health
facilities in the State were high at 79.2%, but immunization care services was very
high on the average at 86.2% (Table 3.12 and Figure 3.18).
39

Figure 3.18: Percentage of the Types of Facilities that Provided Child Welfare
and Immunisation Services
Child welfare services were largely provided by the supported facilities in the State
on weekly basis with 17 (60.7%). Further, 67.9%) of the supported facilities in the
State provided immunization care services on weekly basis. Three-quarters of
secondary facilities and 85.7% of primary facilities provided child welfare services to
clients. Similarly, 62.5% secondary facilities and 95.2 of primary facilities provided
Immunization services to clients. The child welfare and immunization services
captured are largely Infant and Mother TT Immunizations.
3.4.3 Family Planning Services
Table 3.12 and Figure 3.19 show that 75.9% of the selected facilities offered family
planning services.
Figure 3.19: Proportion of the Types of Facilities That Offered FP services
Almost all of the secondary facilities at 87.5 and many of primary facilities at 71.4%
provided FP services. More than half of the supported facilities (53.6%) provided FP
services on demand. There is therefore the need for programme interventions to
strengthen all facilities to provide FP services.
40

3.4.4 STI and HIV Services
The respondents were asked if the supported facilities also offered Syndromic
Management of STIs, HIV Counseling and HIV Testing. The results in Table 3.12
and Figure 3.20 showed that overall, 41%, 34.5% and 75.9% of all the supported
health facilities offered Syndromic Management of STIs, HIV Counseling and HIV
Testing services, respectively.
Figure 3.20: STIs management, HIV counseling and HIV testing
The results depict that provision of HIV counseling and HIV Testing services were
low among the facilities compared to the provision STIs management, which was
high. However, more types of these facilities provided HIV counseling than HIV
testing, which is an indication that HIV Counseling were conducted after some HIV
Testing in line with the ethics and human rights of clients. There is therefore the
need for programme intervention to strengthen facilities to scale up the provision of
HIV Counseling and HIV Testing services.
3.4.5 Obstetric Fistula repair
The health facilities officials were asked to indicate if they, engaged in the repairs of
obstetric fistula; and the results are presented in Table 3.12 depicts only a secondary
facility repaired Obstetric Fistula. Programme interventions should advocate and
strengthen supported facilities to conduct Obstetric Fistula repairs.
3.4.6 Treatment of Minor Ailments
The data in Table 3.12 and Figure 3.21 indicate that almost all the supported
facilities (96.4%) treated minor ailments. According to the results, all secondary
facilities and almost all primary facilities treated minor ailments. This should be
sustained by programme interventions. There is also the need to validate the claim
by primary facility that it does not treat minor ailments, and strengthen it accordingly
to provide treatment for minor ailments to its clients.
41

Figure 3.21: Treatment of Minor Ailments
3.4.7 Referral Services
The provisions of referral services by the types of facilities were generally very high
at 96.5% as shown in Table 3.12 and Figure 3.22.
Figure 3.22: Referral Services
This high level of provision of referral services should be encouraged by programme
interventions the advocacy and provision of referral forms.
3.4.8 Demand Creation Services
The demand creation activities are home visits and community outreaches, the
results of which were shown in Table 3.12 and Figure 3.23.
42

Figure 3.23: Demand Creation Services
Generally, 75.9% and 31.7% of the supported facilities conducted home visits and
community outreaches respectively to create demand for RH/FP/HIV prevention
services. Home visits were conducted on weekly basis in 8 facilities (38.1%) and
monthly in 7 facilities (33.3%). However, community outreach services were held
monthly in 10 facilities (90.9%). The Table and Figure further show that 90.4% of
primary facilities compared to 37.5% of secondary facilities conducted Home visits.
Similarly, 52.3% of primary facilities as against none of the secondary facilities held
Community Outreach.
There is therefore the need to scale up demand creation activities by facilities in the
State for clients to access available services as well as to eliminate or at least
reduce the first two delays (delay in seeking medical assistance, and the delay in
reaching the medical facilities). Facilities should step up community outreach as a
demand creation activity. Programme interventions should bridge the gaps in
provisions of demand creation activities between primary and secondary facilities.
3.4.9 Other Services.
Data collection during the facility assessment in the State did not capture any other
services, including Youth-focused RH services such as Counseling on ASRH.
In summary, most of the services required for quality maternal health care delivery
were provided by the supported health facilities in the State including the Primary
Facilities. However the quality of these services needs to be further investigated to
ensure quality services, especially those provided by the Primary Facilities in view of
the low human resources in the facilities.
3.5 PROVISION OF SERVICES IN THE LAST THREE MONTHS
3.5.1 Total Attendance for Services
Table 3.13 and Figures 3.24a and 3.14b below present the data on total attendance
for services in the last three months (June – August 2009) by residence and type of
facilities in the State.
43

Table 3.13: Frequency distribution of attendance for some health care services in the past 3 months (June-August 2009)
by type of facility and nature of residence.
Types of services
Infants
Residence
Facility
type ANC PNC Del CS
Asst.
Del
Asst
breach
del
Neonates
resuscitated
Neonates
unsuccessfully
resuscitated
fully
immunised
(DPT 3)
Mothers
TT II
Youths
served Total %
Rural/urban MCH 1144 812 471 0 0 18 17 2 3704 1113 411 7692 44.3
PHC 246 83 33 0 0 2 0 0 1121 281 111 1877 10.8
GH 2621 244 659 98 11 20 37 9 330 1983 1352 7364 42.4
Clinic 47 59 23 0 0 0 0 0 31 35 21 216 1.2
Others 80 0 0 0 0 0 0 0 7 43 70 200 1.2
Total 4138 1198 1186 98 11 40 54 11 5193 3455 1965 17349 100.0
23.9 6.9 6.8 0.6 0.1 0.2 0.3 0.1 29.9 19.9 11.3 100.0
Rural MCH 641 677 233 0 0 9 12 2 2341 738 170 4823 27.8
PHC 178 65 15 0 0 2 0 0 1042 240 81 1623 9.4
GH 1530 244 408 98 0 18 34 7 316 1261 660 4576 26.4
Clinic 47 59 23 0 0 0 0 0 31 35 21 216 1.2
Others 80 0 0 0 0 0 0 0 7 43 70 200 1.2
Total 2476 1045 679 98 0 29 46 9 3737 2317 1002 11438 65.9
% rural 59.8 87.2 57.3 100 0 72.5 85.2 81.8 72 67.1 51 65.9
Urban MCH 503 135 238 0 0 9 5 0 1363 375 241 2869 16.5
PHC 68 18 18 0 0 0 0 0 79 41 30 254 1.5
GH 1091 0 251 0 11 2 3 2 14 722 692 2788 16.1
Clinic 0 0 0 0 0 0 0 0 0 0 0 0 0.0
Others 0 0 0 0 0 0 0 0 0 0 0 0 0.0
Total 1662 153 507 0 11 11 8 2 1456 1138 963 5911 34.1
% urban 40.2 12.8 42.7 0 100 27.5 14.8 18.2 28
32.9 49
34.1
44

Figure 3.24a: Frequency distribution of attendance for some health care
services in the past 3 months by type of facility and nature of residence
Figure 3.24b: Frequency distribution of attendance for some health care
services in the past 3 months by residence
According to the data in Table 3.18, a total of 17,349 attended the 29 supported
facilities in the State for different types of services, out of which the higher proportion
of 57.6% attended Primary facilities, while the balance of 42.4% attended secondary
facilities for healthcare services in the last three months. The highest number of
5,193 attendees (29.9%) were Infants fully immunized (DPT 3), followed by 4,138
mothers (23.9%) for ANC services. Attendance for Assisted Delivery services and
Neonates unsuccessfully resuscitated with 11 attendees (0.1%) each reported the
least attendance in the last three months (June-August 2009).
The distribution of total attendance for different healthcare services by residence
shows that 11,438(65.9%) attended rural facilities compared to 5,911 (34.1%) that
attended facilities in the urban areas in the State. Also, 72.5% of attendances for
ABD at 77.1 and 85.2% of Neonates resuscitated were in rural facilities with
45

concentration in GHs. This is compared to 27.5% for ABD and 14.8% for Neonates
resuscitated in urban facilities. However, all the 11 cases of Assisted Delivery
services took place in urban areas, while all the cases of 98 CS occurred in rural
areas. Further, attendance for PNC at 87.2%) and Mother TT II services at 67.2%
were in rural facilities with high numbers to GHs. Furthermore, 72% of infants fully
immunized with DPT 3; 81.8% of Neonates unsuccessfully resuscitated; 59.8% of
attendance for ANC, and 57.2% of Deliveries were to rural facilities, with
concentration of the attendance to the GHs. These results revealed significant
variations in attendance for services in the last three months between the rural and
urban areas.
There was large gaps between attendance for ANC at 4,138 (23.9%) and those of
PNC services at 1,198 (6.9%) and Delivery care services at 1,186 (6.8%) in the
facilities. The slight difference in the figures of attendance for delivery care services
in the last three months as against those for PNC suggest that clients delivered
outside facilities before visiting supported facilities for PNC services. These results
further confirm the 2008 NDHS results that a sizeable number of deliveries in the
Territory take place outside the health facilities. It also shows that PNC services was
not a popularly sought for healthcare service by most citizens of the State. The Table
also shows that some of the health facilities provided 98 Caesarian section services
in the previous 3 months. The low availability of this CS services are pointers to
issues of health manpower, equipment and policy to perform CS in the facilities. The
low number of youths served at 1,968 almost evenly distributed between rural
facilities at 51% and urban facilities with 49% indicate very low availability of youth
friendly services in the supported healthcare facilities in the State.
3.5.2 Family Planning Services, Contraceptives and Stock Outs
3.5.2.1 Availability of FP Services
The results in Figure 3.25 reveal that on the average, 19 (65.5%) of the 29 supported
facilities offered FP services.
Figure 3.25: Percentage availability of FP Services by the Types of Facility
46

The distribution of availability of FP services by the types of health facility indicates
that FP services were available in all GHs, and 11 (52.4%) of 22 primary facilities.
Interventions should strengthen primary facilities to offer FP services.
3.5.2.2 Number of FP acceptors
Data on FP acceptors was disaggregated by the number of FP new acceptors and
the number of FP revisits. Table 3.14 presents the data on the number of FP
acceptors by types and according to residence and types of facilities.
Table 3.14: Frequency Distribution of FP clients in the last three months by the
types of acceptors, residence and types of facilities.
Total in the last 3 months
Residence Facility type
New
acceptors
Number of
revisits Total %
Rural/urban MCH 70 105 175 45.9
PHC 17 8 25 6.6
GH 81 80 161 42.3
Clinic 8 3 11 2.9
Others 5 4 9 2.4
Total 181 200 381 100.0
% 47.5 52.5 100
Rural MCH 50 75 125 32.8
PHC 5 0 5 1.3
GH 43 47 90 23.6
Clinic 8 3 11 2.9
Others 5 4 9 2.4
Total 111 129 240 63.0
% rural 61.3 64.5 63
Urban MCH 20 30 50 13.1
PHC 12 8 20 5.2
GH 38 33 71 18.6
Clinic 0 0 0 0.0
Others 0 0 0 0.0
Total 70 71 141 37.0
% urban 38.7 35.5 37
47

Figure 3.26a: Frequency Distribution of FP clients in the last three months by the
types of acceptors and types of facilities.
Figure 3.26b: Frequency Distribution of FP clients in the last three months by the
types of acceptors and residence.
The results reveal that the supported facilities recorded a total of 381 new acceptors,
out of which secondary facilities had 161 (42.3%) compared to primary facilities with
220 (57.7%); and 240 (63%) were from the rural areas compared to 141 (37%) from
the urban areas. 64.5% of the 229 revisits for FP services in the last three months
reported by the facilities were from the rural areas as against 35.5% in the urban
areas. Similarly, 61.3% of the 181 new acceptors were in rural areas as against 70
(38.7% in urban areas. These results imply low no number of FP acceptors in the 29
supported facilities. Interventions should scale up the number FP acceptors through
vigorous demand creation activities for RH/FP services.
3.5.2.3 Stock out status
Stock out is a situation where the demand or requirement for any
commodity cannot be fulfilled from the current (on hand or available)
inventory; or simply a situation where stocks of commodities have run out
48

or are not available. Figure 3.27 depicts the status of contraceptives stock outs by
the types of supported facilities in the State.
Figure 3.27: Percentage availability of Contraceptives by Types of Facility
The information in Figure 3.27 shows that overall; only 27.6% of the supported
facilities in the State had contraceptives, while the remaining majority accounting for
72.4% had contraceptive stock outs. The contraceptives stock outs were higher in
Primary facilities with 72.7% than in the GHs with 50%. These high proportions of
stocks in the supported facilities portend threat to the achievement of ICPD agenda
and MDG 5. Programme intervention should ensure steady availability of
Contraceptives through timely procurement and accurate forecasting.
3.5.2.4 Type and number of contraceptives available
During the facility survey exercises, information was collected on the types and
numbers of contraceptives available for those facilities which had contraceptives.
The data on these are shown in Table 3.15.
Table 3.15: Distribution the types and numbers of contraceptives available
Type of HCF Type of Contraceptive Quantities
PHC Combined Pills Not provided
Combined Pills
Not provided
Injectables
Not provided
GH
Male Condom
Not provided
Progesterone only pills Not provided
Combined pills
Not provided
Injectables
Not provided
MCH
Male Condom
Not provided
Clinics
NA
Others
NA
It was observed that most types of the facilities had at least two types of
contraceptives, namely Combined Pills and Injectables. This is below the minimum
packages that guarantee the rights of clients to choice. However, the quantities of all
49

the types of contraceptives available were not accounted for by most the supported
facilities in the State, which indicate poor record keeping that require CLMS training.
The results also show that 2 primary facilities did not report availability of any types
of Contraceptives, probably due to Stock outs. Programme intervention should
ensure steady availability of minimum types of Contraceptives to satisfy the rights of
clients to choices also through timely procurement and accurate forecasting.
3.5.2.5 Number of FP complications referred
The distribution of FP complications referred in the last three months in the State is
shown in Table 3.16.
Table 3.16: No of FP complications referred by types of facilities and residence
Number of FP
complications
Residence Facility type referred Total %
Rural/urban MCH 2 2 25
PHC 0 0 0
GH 5 5 62.5
Clinic 1 1 12.5
Others 0 0 0
Total 8 8 100
Rural MCH 0 0 0
PHC 0 0 0
GH 2 2 25
Clinic 1 1 12.5
Others 0 0 0
Total 3 3 37.5
% rural 37.5 37.5
Urban MCH 2 2 25
PHC 0 0 0
GH 3 3 37.5
Clinic 0 0 0
Others 0 0 0
Total 5 5 62.5
% urban 62.5 62.5
The results show that a total of 8 FP complications were referred in the last three
months by some of the supported facilities. Out of this number, 5 (62.5%) were
referred by secondary facilities while the remaining 3 (37.5%) were referred by
primary facilities. Similarly, 3 (35.7%) were referred in rural areas compared to 5
(62.5%) referred in urban areas. Facilities should therefore be strengthened to
identify and attend to, or refer FP complications in timely fashion.
50

3.5.2.6 Availability and adequacy of FP room
Data was not collected on availability and adequacy of FP room to ensure comfort
and confidentially of clients, including availability of model and equipment.
3.6 INTEGRATED SRH/FP/HIV SERVICES
Integrating SRH/FP/STI/HIV prevention and treatment services is critical for UNFPA
work in ensuring universal access. Integration requires that health care workers can
provide an appropriate comprehensive package of services under one roof, and refer
clients to other services if required. However, attempts to integrate SRH services
with FP/HIV prevention services have encountered challenges at the programme
and service level, including difficulties in allocating and coordinating responsibilities;
ensuring effective communication between staff in programmes; training staff with
appropriate skills to meet a broader range of demands; and strengthening referral
services. The following section present and discuss issues of integrated SRH/HIV
prevention services.
3.6.1 Provision of Integrated SRH/HIV Services
Integrated SRH/HIV prevention services were provided in only 27.6% of the facilities
on the average (Figure 3.28).
Figure 3.28: Percentage of Facilities Providing Integrated SRH/HIV services by
the Types of Facility
Specially, 62.5% of the secondary facilities and 14.3% of the primary facilities
provided integrated SRH/FP/HIV prevention services. Three secondary facilities
(37.5%) and 18 primary facilities (81.8%) did not report the provision of any types
integrated SRH/HIV prevention services. These results suggest that the provision of
integrated SRH/FP/HIV prevention services by the supported was low. Programme
interventions should strengthen all facilities to provide minimum package of
integrated SRH/HIV prevention services through training and provision of supplies,
equipment and consumables.
3.6.2 Types of Integrated SRH/HIV Services
FP and STI management is largely the integrated SRH/FP/HIV prevention services
provided by the supported facilities (Table 3.17).
51

Table 3.17: Types of Integrated SRH/HIV&AIDS services provided by Type of
HCFs
PHC FP and STIs Management 1
HCT, PMTCT, ASRH and FP 1
HCT, FP and STIs Management 1
GH
HCT, PMTCT, FP and STIs Management 2
HCT, PMTCT, ASRH, FP and STIs Management 1
HCT, PMTCT, ASRH and FP 1
MCH HCT, ASRH, FP and STIs Management 1
Clinic NA NA
Others NA NA
The results depict that the GHs and some primary facilities provided different types
of integrated SRH/FP/HIV prevention services. In the mean time, two types of
primary facilities, namely the Clinic and Others did not provide any type of integrated
SRH/FP/HIV prevention services at all. There is therefore the need to scale the
provision of integrated SRH/FP/HIV prevention services in the supported facilities in
general, and in the Primary facilities in particular through training, provision of
supplies and equipment, advocacy and policy dialogues. Also, facility-specific
challenges involved in the provision of these critical services should be identified for
appropriate strengthening measures.
3.7 EMERGENCY OBSTETRIC AND NEW BORN CARE SERVICES
Emphasis on making EmONC available to all women who develop complications is
central to UNFPA’s efforts to reduce maternal mortality worldwide. This is because
the major causes of maternal mortality, namely haemorrhage, sepsis, unsafe
abortion, hypertensive disorders and obstructed labour, can be treated at well-staffed
and well-equipped HCF.
3.7.1 Basic Emergency Obstetric and New Born Care Services
BEmONC provided in primary health care centres includes the capabilities for the:
Administration of Parenteral Antibiotics,
Administration of Uterotonic Drugs (Oxytocins, Engometrine, Misoprostol)
Administration of anticonvulsants for pre-Eclampsia and Eclampsia (such
as Magnessium Sulphate)
Manual removal of the Placenta
Perform removal of retained products following miscarriage or abortion
(e.g Manual Vacuum Aspiration, Dilation and Curettage)
Perform assisted vaginal delivery, preferably with vacuum extractor,
forceps delivery.
Newborn care
It is expected that less than or equals to 15% of all births should take place in
B/CEmONC facilities. Table 3.18 and Figure 3.29 present data on percent
distribution of the supported HCFs by the signal functions of BEmONC services.
Table 3.19 summarise the reasons why BEmONC services were not provided.
52

Table 3.18: Availability of Basic Emergency Obstetric and Newborn Care Services in the selected HCFs
Signal Functions
BEmONC
Type and number of facilities
PHC GH MCH Clinic others
7 8 12 1 1
Average
Admin of Parenteral
antibiotics 28.6 100 41.7 100 0 55.2
Administer Uterotonic
drugs 85.7 100 83.3 100 100 89.7
Administer
anticonvulsants 0 75 50 100 0 44.8
Manual removal of
placenta 14.3 87.5 58.3 0 100 55.2
Removal of retained
products 42.9 75 50 0 0 51.7
Perform assisted
vaginal delivery 0 12.5 0 0 0 3.4
Resuscitation of
Newborns
Data not collected
Reasons for not providing the
EmOC
Freq
No indication 2
Policy issues 2
Training issues 2
Supplies, equipment and drugs issues 1
Training issues 2
Policy issues 1
Policy issues 1
Training issues 1
No indication 12
Policy issues 1
Supplies, equipment and drugs issues 1
Training issues 1
No indications 7
Training issues 2
Policy issues 2
Supplies, equipment and drugs issues 1
No indication 8
Training issues 8
Supplies, equipment and drugs issues 7
Policy issues 3
No indication 4
Figure 3.29: Availability of Basic Emergency Obstetric and Newborn Care
Services in the selected HCFs
Table 19: Summary of reasons for not providing BEmONC
Reason Frequency %
Training issues 16 55.2
Supplies, equipment and drugs issues 10 34.5
Policy issues 9 31.0
No indication 23 79.3
The results show that Administration of Uterotonic Drugs was available in 89.7% of
the 29 supported facilities in the State. This was the only signal function that scored
53

high. The availability of five other signal functions were average, ranging between
44.8% for Administration of Anticonvulsants to 55.5% each for Administration of
Parenteral Antibiotics and Manual Removal of the Placenta. The availability of
Assisted Delivery was extremely low at 3.4%. However, data was not collected on
the seventh signal function, which is Newborn Care Services. The summary of the
reasons why the signal functions were not performed in the supported HCFs show
that Training issues; Supplies, equipment and drug issues; and Policy Issues were
the most frequency reported. These findings suggest that interventions should
support advocacy for the State to develop and implement EmONC policy and Health
System Strengthening (HSS) Plan to facilitate the provision of BEmONC services.
3.7.2 Comprehensive Emergency Obstetric and New Born Care Services
CEmONC typically delivered in GHs, MHCs and some CHCs includes all the
BEmONC signal functions above, plus Caesarean Section, Safe Blood Transfusion
and Care to the sick and low birth weight newborns, including resuscitation. The
guidelines jointly issued in 1997 by WHO, UNICEF, and UNFPA, recommended that:
‣ Every 500,000 people should have four facilities offering BEONC and one
facility offering CEmONC.
‣ To manage obstetric complications, which is the life-saving component of
maternity care; a HCF must have at least two skilled attendants covering 24
hours a day and seven days a week, assisted by trained support staff.
‣ To manage complications requiring surgery, the facilities must have a
functional operating theatre, more support staff and must be able to
administer blood transfusions and anaesthesia.
Information on the status of CEmONC in the State was obtained from the supported
HCFs and the results are discussed below. Table 3.20 and Figure 3.30 display the
data with respect to the provision of CEmONC services in the supported HCFs in the
State. Table 3.21 gives the reasons why the provision of CEmONC services was a
challenge in the facilities.
Table 3.20: Provision of CEmONC service in the supported HCFs in the State
Signal Functions
CEmONC
Type and number of facilities
PHC GH MCH Clinic others
7 8 12 1 1
Average
Perform Blood
transfusions 14.3 87.5 0 0 0 27.6
Perform Caesarian
Section 0 12.5 0 0 0 3.4
Reasons for not providing the
EmOC
Freq
Training issues 1
Policy issues 6
Supplies, equipment and drugs issues 4
No indication 5
Training issues 5
Policy issues 16
Supplies, equipment and drugs issues 1
No indication 3
54

Figure 3.30: Provision of CEmONC service in the supported HCFs in the State
Table 3.21 Summary of reasons for not providing CEmONC
Reason Frequency %
Supplies, equipment and drugs issues 5 17.4
Policy issues 22 75.9
Training 6 20.7
No indication 8 27.6
Table 3.20 and Figure 3.30 depict that 27.6% and 3.4% of facilities performed Blood
Transfusion and Caeserian Sections, respectively. The proportion for Blood
Transfusion was higher than the minimum requirement stipulated by WHO. But the
proportion for CS was below the minimum requirement stipulated by WHO. The
results in Table 3.21 show that the greatest challenge to the provision of CEmONC
services by the supported facilities in the State was Policy issues. Other challenges
however were Training Issues and Supplies, Equipment and Drugs Issues. These
results corroborate the findings on BEmONC services, which therefore reinforce the
need for interventions to advocate for a policy on EmOC in the State and HSS plan
or strategy that hinge on training; and supplies, equipment and drugs.
However, the data provided in the Table and Figure above is not sufficient to
determine status of CEmONC in the State. The results may suggest that many
facilities effectively provided CEmONC services; but data on skilled manpower
requirement, availability of a functional operating theatre, and support staff that are
able to administer blood transfusions and anaesthesia are not available to justify
conclusive statement.
3.7.3 Total number of obstetric complications in the last three months
Data was collected on records of obstetric complications in the last three months,
and the results are shown in Table 3.22. The summaries of these are shown in
Figure 3.31a and 3.31b.
55

Table 3.22: Number of Obstetrics Complications.
Number
Residence
Facility
type
Referrals for
pregnancy
related
complications
Persons
transfused
Obstetrics
complications
in the last
three months Total %
Rural/urban MCH 35 0 39 74 18.3
PHC 5 0 6 11 2.7
GH 57 125 133 315 77.8
Clinic 0 0 0 0 0.0
Others 5 0 0 5 1.2
Total 102 125 178 405 100.0
% 25.2 30.9 44.0 100.0
Rural MCH 17 0 18 35 8.6
PHC 5 0 6 11 2.7
GH 44 62 113 219 54.1
Clinic 0 0 0 0 0.0
Others 5 0 0 5 1.2
Total 71 62 137 270 66.7
% Rural 70 49.6 77 66.7
Urban MCH 18 0 21 39 9.6
PHC 0 0 0 0 0.0
GH 13 63 20 96 23.7
Clinic 0 0 0 0 0.0
Others 0 0 0 0 0.0
Total 31 63 41 135 33.3
% Urban 30 50.4 33 33.3
Figure 3.31a: Number of Obstetrics Complications by Types of Facilities
56

Figure 3.31b: Percent distribution of Obstetrics Complications by Residence
The results in Table 3.22 and Figure 3.31a reveal that a total of 405 obstetric
complications were seen in the last 3 months, out of which 178 (44.0%) were
Obstetrics complications, 125 (30.9%) were persons transfused, and 102 (25.2%
were referrals for pregnancy related complications. The distribution of the number of
complications seen in the last three months by the types of facilities show that higher
proportion of complications at 315 (77.8%) were reported in the GHs, while 90
(22.2%) were reported by the primary facilities. In terms of residence, two-third
(66.7%) of the complications was seen in the rural facilities compared to 33.3% seen
in the urban facilities. The details of the distribution of the numbers of the
complications seen in the last 3 month by the types of complication are shown in
Table 3.22. These results imply that there were variations in the number of
complications seen in the last three months between the types of health facilities as
well as between the rural and urban facilities.
However, the data in Table 3.23 below indicate that Ante/post partum haemorrhage,
Pre-Eclampsia/Eclampsia and Obstructed labour and were the most frequently
reported by the supported facilities to be the most re-occurring types of obstetric
complications.
Table 3.23: Types of obstetric complications
S/N Types
Frequency
1 Ante/post partum haemorrhage 11
2 Obstructed labour 8
3 Pre-eclampsia/Eclampsia 2
4 Others 1
The supported facilities in the State should therefore strengthen to tackle these types
of obstetric complications. Similarly, programme intervention should be tailored
towards awareness on the implications of obstructed labour and Ante/post partum
haemorrhage.
57

3.7.4 Other requirements for EmONC services
3.7.4.1 Availability and Utilisation of Referral forms
Availability of referral forms enhances referral of clients with complications for quality
health services. Referral forms were available in all the supported facilities (100%)
as shown Figure 3.32, but only 34.5% of the forms were used to refer clients for
quality healthcare services.
Figure 3.32: Percentage distribution of Facilities that had and utilised Referral
Forms by the Types of HCFs
These findings suggest that there were gaps between availability and utilisation of
referral form. The non-availability of referral forms in some of the supported facilities
has negative implications for the health of clients with complications. None the less,
almost all facilities did not state any major reason why referral forms were not used
as shown in Table 3.24.
Table 3.24: Percentage distribution of Facilities that had Referral Forms by the
reasons for non-utilisation of these referral forms
Reasons for not using referral forms Frequency %
Finished 1 5.3
Unstated 18 94.7
Total 19 100
Only a facility said it did not used referral form in referring clients because the forms
were finished. The supported facilities made referrals to largely secondary facilities
(General Hospitals) and a tertiary institution – UMTH Maiduguri. The details of other
facilities where referrals were made in the State as contained in Table 3.25 below.
None the less, the results suggest that referrals were made to appropriate places for
prompt, timely and quality healthcare services.
58

Table 3.25: Names of Health Facilities where referrals are made in the State
Name of HCF
Frequency
UMTH Maiduguri 2
Specialist Hospital 2
General Hospital, Dikwa 1
General Hospital 13
General Hospital, Biu 2
GH/MCH 1
General Hospital, Ngala 1
Umaru Shehu 1
GH Adaham 2
General Hospital, Uba 1
General Hospital, Uba/UMTH 1
Not stated 2
3.7.4.2 Provision of Birth Preparedness Services by the Types of HCFs
The provision of birth preparedness services is a determinant in minimising one of
the delays to access service delivery that inhibits improvements in maternal health.
The data on birth preparedness services are shown in Table 3.26.
Table 3.26: Provision of Birth Preparedness Services by the Types of HCFs
Type of HCFs Yes No Unstated Total
PHC 0 6 1 7
GH 1 7 0 8
MCH 3 9 0 12
Clinic 0 1 0 1
Others 0 0 1 1
Total 4 23 2 29
% 13.8 79.3 6.9 100.0
The results in Table 3.26 show that only 4 facilities (13.8%) provided Birth
Preparedness services to enhance the maternal health. Three-quarters of the
facilities that provided any birth preparedness services were Primary Facilities, while
the remaining 1 was a secondary facility. This means that majority of the facilities
(79.3% did not provide any Birth Preparedness services, while 2 facilities (6.9%) did
not state their status of Birth Prepared services. Majority of the facilities should
therefore be strengthened by programme interventions to provide Birth
Preparedness services.
3.7.4.3 Functional means of transport for emergencies
Functional mean of transport eliminates one of delays accessing service delivery.
Only the 6 supported facilities representing 20.7% had a functional means of
transport (Table 3.27).
59

Table 3.27: Availability of Functional Means of Transport
Type of HCFs Number % Yes
PHC 7 0
GH 8 50
MCH 12 8.3
Clinic 1 0
Others 1 100
Total/Average 29 20.7
The distribution of availability of functional means of transport by the types of
facilities shows that 4 (50%) of the 8 GHs had functional means of transport, while 2
(9.5%) of the 22 primary facilities reported functional means of transport. Further,
according to the results in Table 3.28 below, Motor Ambulance (61.5%) and Others
(38.5%) were the types of functional means of transport.
Table 3.28: Type of, who provided and maintained the functional means of
transport
Type of functional means of transport Provider Maintenance
Motor ambulance 4 Government 3 Government 2
Others 1 Government Government
Others individual Government
These Motor Ambulances and Others were largely provided by the Government
(69.2%), while one other type of means of transport was provided by an Individual.
However, all the Motor Ambulances and Others were maintained by Government.
Programme interventions should identify individual Philanthropist and advocate
leveraging support in the provision and maintenance of functional means of transport
to its supported facilities.
3.7.4.4 Availability of maternity equipment in health facility
The study examined the availability of basic maternity equipment in health facility,
and the results are presented in Table 3.29. The data in Table 3.29 shows that all
the types of facilities have dedicated maternity and delivery beds. The distribution of
the beds according to the types of beds reveals that there were 509 total beds; 102
maternity beds and 41 delivery beds in the supported facilities. The distribution of
these types of beds by types of facilities show that 62.7% of total beds, 51% of
maternity beds and 29.3% of delivery beds were available in secondary facilities as
against 37.3% of total beds, 49% of maternity beds and 70.7% of delivery beds in
primary facilities. The distribution of beds by residence reveal 68.5% of the total
beds, 53.9% of maternity beds, and 68.3% of delivery beds were available in the
rural areas compared 31.5% of total beds, 46.1% of maternity beds, and 31.7% of
delivery in rural areas. These results imply disparity in the availability of all the types
of beds between the types of facilities and between the rural and urban areas, which
needs to be addressed.
The results of the assessment also show an average of 18 total beds, 4 maternity
beds, and 1 delivery beds to a facility. Figure 3.33a and 3.33b below present detail
distribution of the beds by the types of facilities and residence respectively.
60

Table 3.29: Availability of maternity equipment in health facility by types of
beds, residence and facility types
Number of beds by type
Residence Facility type
Total Mat beds Del beds
Rural/urban MCH 88 30 19
PHC 98 16 8
GH 319 52 12
Clinic 2 2 1
Others 2 2 1
Total 509 102 41
Rural MCH 35 10 11
PHC 84 14 7
GH 200 27 8
Clinic 2 2 1
Others 2 2 1
Total 323 55 28
% 63.5 53.9 68.3
Urban MCH 53 20 8
PHC 14 2 1
GH 119 25 4
Clinic 0 0 0
Others 0 0 0
Total 186 47 13
% 36.5 46.1 31.7
Figure 3.33a: Number of the Types of Beds in the selected Facilities.
61

Figure 3.33b: Percent distribution of the Types of Beds in the selected
Facilities by Residence.
The data in the Figures show confirm the concentration of total beds and maternity
beds in the GHs and in rural areas.
3.7.4.5 Availability of essential drugs and consumables
According to WHO 2002, essential medicines are those that satisfy the priority health
care needs of the population. They are selected taking into cognisance the public
health relevance, evidence on efficacy and safety, and comparative costeffectiveness.
Essential medicines are intended to be available within the context of
functioning health systems at all times in adequate amounts, in the appropriate
dosage forms, with assured quality and adequate information, and at a price the
individual and the community can afford. The implementation of the concept of
essential medicines is intended to be flexible and adaptable to many different
situations; exactly which medicines are regarded as essential remains a national
responsibility. Other healthcare consumables and reagents include tapes, testing
kits, cleaning products, hygiene monitoring systems, and record keeping materials
(forms) that are use for different purposes. Some of these consumables are
disposables while other items are re-usable through sterilisation. The availability of
essential drugs enhances EmONC service delivery. However, data was not collected
on essentials drugs and consumables to serve as the benchmark for backstopping.
3.7.4.6 Methods of Sterilization
Method of sterilisation also facilitates EmONC service delivery. Sterilisation in this
context refers to any process that effectively kills or eliminates transmissible agents
(such as fungi, bacteria, viruses, spore forms, etc.) from a surface, equipment or
medication through application of heat (steaming and boiling), chemicals, irradiation
(gas or ionizing), high pressure or filtration. Information in Figure 3.34 indicates that
the common methods of sterilisation in the supported HCFs were Boiling at 55.2%
and Disinfection (37.9%) and Autoclaving at 6.9%.
62

Figure 3.34: Percent Distribution of selected HCFs by Methods of Sterilisation
These results suggest that many of the supported HCFs in the State practiced
Disinfection and Boiling, which may not kill all types of bacteria and viruses. In view
of the concerns in an era of HIV/AIDs scourge, especially due to complicities with
practice of Boiling and Disinfections; interventions should scale up the use of
Autoclaving as a method of sterilisation that at less than 10% at the moment. This
implies that interventions have to support the provision and functionality of
Autoclaving machines, including capacity building for health workers.
3.8 DATA COLLECTION FORMS, SUPERVISION AND COMMUNITY
SUPPORT
3.8.1 Availability, utilisation and transmission of RH/FP data forms
On the average, RH/FP data forms were available in 16 (58.2%) of the supported
facilities, and 75% of these available forms were utilized for data collection and
collation (Table 30).
Table 3.30: Availability of RH/FP data forms by the Types of HCFs and where
data is sent to
Characteristics Number % Yes % Usage
Type of HCFs
PHC 7 71.4 40
GH 8 62.5 83.3
MCH 12 50 100
Clinic 1 0 NA
Others 1 0 NA
Total 29 58.2 75
Where RH/FP data collected and collated are sent to Frequency %
PHC Dept LGA 1 8.3
LGA HQ 2 16.7
SMOH 11 91.7
Specialist Hospital 1 8.3
63

Most of the collected and collated RH/FP data forms (91.7%) are submitted to the
SMOH. Others were submitted to LGA HQ (16.7%) and PHC Department and
Specialist Hospital with 1 (8.3%).
3.8.2 Other statistical data forms
Generally, 82.8% of the supported facilities had other statistical data forms (Figure
3.35).
Figure 3.35: Availability of other statistical data by the Types of HCFS
There is the need to strengthen the facilities for data management, by supporting the
provision of NHMIS forms, which capture other statistical data.
3.8.3 Types and quantities of IEC materials available -
IEC materials on Malaria and Immunisation were reported by the supported facilities,
and the results are shown in Table 3.31.
Table 3.31: Distribution of IEC materials available in the facilities
Types of IEC materials Frequency Quantities
Malaria 2 Not provided
Immunisation 17 Not provided
The results also show quantities of IEC materials available were not accounted for
by all the facilities to create awareness on available RH/FP services. There is the
need for programme interventions to support and provide culturally sensitive IEC
materials on UNFPA mandate areas, including VVF, HIV/AIDS and FP to all
facilities.
3.8.4 Supervision of facilities by LGAs
LGA has the responsibility to supervise health facilities within its jurisdiction. Table
3.32 present data on supervision of facilities by the authorities of the LGA.
64

Table 3.32: Supervision of HCF by officials of the LGA department
Characteristics Number % supervised
Type of HCF
PHC 7 85.7
GH 8 0
MCH 12 91.7
Clinics 1 100
Others 1 100
Total/Average 29 65.5
Last time of supervisory visit Frequency %
Yesterday 1 5.3
Last two week 1 5.3
Last month 14 73.7
Last two month 1 5.3
Last quarter 2 10.5
Total 19 100.1
The data in Table 3.32 indicate that 65.5%) of the facilities reported that they were
supervised by the LGA officials. None of the secondary facilities was however
supervised by the LGA officials. The results also showed that the last date of
supervision by the LGA officials was last month for 73.3% of the supported facilities.
Other dates of supervisions were last quarter with 10.5%; yesterday, last two weeks
and last two months with 5.3% each. There is therefore the need to strengthen
monthly supervision of facilities by the LGA to ensure standard and quality provision
of healthcare services.
3.8.5 Village Health Committees
VHCs provide support to facilitate and strengthen service delivery. Tables 3.33
present data on availability, activities and meetings of functional VHCs. The data in
Table 3.33 depict that 65.5% of the supported facilities on the average had VHCs,
out of which 84.2% was functional VHCs. Almost all Primary facilities at 80.9%
reported having VHCs, out of which 82% were functional. Only 2 secondary facilities
had VHCs, and all were functional. The major activities of functional VHCs were not
indicated. However, 73.3% of VHCs held their meeting monthly to discuss
challenges and the way forward to strengthen health facilities. Others held their
meetings quarterly and fortnightly and every two months.
65

Table 3.33: Existence, Functionality and Meetings of VHCs
Characteristics Total No % Yes exist Functional
Types of HCFs
PHC 7 85.7 83.3
GH 8 25 100
MCH 12 83.3 80
Clinic 1 100 100
Others 1 0 NA
Total/ Average 65.5 84.2
Activities performed by functional VHC Frequency
No activity was mentioned
How often conduct meetings %
Fortnightly 1 6.7
Monthly 11 73.3
Every two months 1 6.7
Quarterly 2 13.3
Total 15 100.0
4. RECOMMENDATIONS
Based on the findings of the assessments, recommendations are suggested under
the major sub-heading as follows:
Background information and physical status of facilities
Validate the findings of the assessment periodically to monitor progress
toward CPAP.
Conduct further analysis to obtain facility-specific data for health system
strengthening.
44.8% of the health workers were Nursing and Midwifery professionals while
41.1% were CHEWs. Only 13.8% were Medical Doctors. Interventions should
ensure adequate skill mix and strengthen the skills of existing community
health workers to provide some BEmONC services.
26.7% of the facilities were secondary facilities compared to primary facilities
at 73.3%. This ratio of the secondary facilities to primary facilities departs
slightly from the criteria for UNFPA oprogramme support. Intervention should
streamline the facilities in line with EmONC guidelines for support.
Strengthen 6.9% of the health facilities with dirty physical status and 27.5% of
maternity wards/delivery rooms with dirty or very dirty floors; to make them
attractive to clients to access quality health services.
Provide curtains to 65.5%) of the maternity wards or rooms in the supported
facilities that were without curtains to guarantee the rights of clients to privacy
and confidentiality, and make them more attractive.
Ensure availability of functional amenities, especially water in 51.7%, Toilets
in 6.9% and Bathroom in 10.4% of the supported facilities, with a view to
enhance access and provision of quality services. Also validate the status of
unstated amenities at 34.5% for source of light and at 6.9% for water and
13.8% for Curtains.
Collect and analyse data on methods of waste disposal.
66

Create awareness on the implications of the commonly reported health
problems by the supported facilities. The most frequently occurring health
problems were - early marriage, teenage pregnancy, miscarriages/induced
abortions, VVF/RVF, FGC and STIs/HIV/AIDS.
Availability of health workers and capacity building received
• Strengthen the supported health facilities with adequate numbers of skilled
health workers by ensuring timely recruitments of new staff and the even
distribution of the existing skilled health workers between primary facilities
with 35% and secondary health facilities (65%) of these health workers, since
most of facilities were in rural areas.
• There were no Specialist Doctors in the supported facilities. Only 10 MOs
were however available. Similarly, there only 110 Nursing and Midwifery
professionals, with 63.8% in the secondary facilities. Programme interventions
should advocate availability of Specialist Doctors, additional MOs and
adequate numbers and re-distribution of Nursing and Midwifery professionals
between primary and secondary facilities.
• Interventions should further ascertain skill mix of available health workers visà-vis
the provision and support for 24 hours services provision, 7 days a
week; including the achievement of minimum package of integrated SRH/HIV
prevention services.
• There were no Pharmacists in the supported facilities. Only 2 Pharmacy
Assistants were available to dispense drugs. There were also scarcity of MLT
and MLA to diagnose specimens, especially in rural facilities. Hence,
intervention should advocate for availability of Pharmacists and MLT for the
supported facilities to function optimally and contribute their quota towards
effective management of the HIV/AIDS scourge.
• There were only 11 Health Educators, out of which only 1 was working in a
secondary facility. To facilitate the achievement of community hygiene and
health, there is the need to strengthen facilities with Health Educators.
• None of 851 health workers in the supported facilities have received any
forms of training at all. Interventions should validate this finding in view of the
fact Borno State is an old UNFPA progarrme State; and step up capacity of all
types of health workers on ELSS, LSS, MLSS, VVF/RVF, CLMS, FP services,
in order to enhance the provision of quality EmONC services.
Provision of, and attendance for healthcare services
The supported facilities in the State provided all the types healthcare service,
except youth-focused services. There is therefore the need to strengthen
facilities to provide youth-focused care and services.
The provision of healthcare services ranged from the highest of 90.4% for
Referral services and 89.7% each for ANC and Delivery Care Services to the
lowest of 3.6% of the facilities for fistula repairs. Therefore, there is the need
for interventions to:
‣ Ensure all facilities provide the types of services that they were meant
to provide.
‣ Bridge the gaps in the provision of ANC services on the one hand with
the provisions of PNC and Delivery care services on the other hand.
‣ Also bridge the gaps the provision of HIV Counseling and HIV Testing
including STI management.
67

Similarly, a total of 17,364 clients attended the supported facilities in the State
in the last three months for healthcare services. Attendance for these
healthcare services in the last 3 months were largely infants fully immunized
for DPT3 and the least for Assisted Deliveries and Neonates unsuccessfully
resuscitated. And like the information on the provision of healthcare services,
there were significant gaps between attendance for ANC at 45.8%, and PNC
and delivery care services that accounted for mere 12.3% and 7.4%
respectively of the total attendance in the last 3 months. Hence, there is the
need to create demand for RH/FP/HIV services to increase access as well as
to bridge the gap between attendance for ANC, PNC and delivery care
services.
Demand creation activities were lower in the GHs compared to the Primary
facilities. Programme interventions should therefore ensure all facilities,
conduct demand creation activities for RH/FP/HIV services at the facility-level,
while sustaining demand creation activities in the other types of facilities.
Sustain the high level of referral services and system, and strengthen referrals
from the secondary facilities to the Tertiary institutions.
Ensure the provision of youth friendly RH services, ASRH and STI
management.
Ensure that facilities provide and keep records of EmONC such Assisted
Delivery and Assisted Breech Deliveries.
Family Planning services
• Availability of FP services was moderate at 65.5%, and barely half of the
Primary Facilities provided these FP services. Hence, interventions should
ensure that all the types of FP services are available and accessible in all
Primary facilities; and to also ensure availability of, and strengthen FP rooms;
with a view to enhance acceptance and utilization of FP services.
• There were low patronages for FP services (new acceptors and revisits) at
only 381 in the last 3 months. In view of the scouring population of the State,
interventions should therefore strengthen demand creation for FP services.
• Collect and analyse data on status of FP rooms, including availability of
commodities and equipment, and the provision of comfort and confidentiality
to clients.
• 72.4% of the facilities reported stock out of contraceptives. Therefore,
interventions should eliminate contraceptive stock outs, by ensuring steady
availability and accessibility of contraceptives.
• The quantities of the various types of contraceptives available were not
provided, which may indicate poor RHCS management. There is therefore the
need for result-based RHCS management to capture, document and account
for the quantities of contraceptives available.
• Some records of FP complications were reported by GHs - (25%), Primary
facilities (37.5%). Programme interventions should ensure that all the types of
facilities document FP complications, including referrals. Interventions should
support management of FP complications.
Integrated SRH/FP/HIV services
• 72.4% of the facilities did not provide integrated SRH/FP/HIV services. Hence,
programme intervention should scale up the provision of integrated
68

SRH/FP/HIV services, especially in the PHCs through training, sensitization
and dissemination of protocols for integrated SRH/FP/HIV services.
• Some facilities provided some types of integrated SRH/FP/HIV services,
including FP services and STI management. But many facilities did not
provide any form of integrated SRH/HIV services. Programme interventions
should be strengthen facilities to provide a minimum of four integrated
SRH/HIV services, including HCT, PMTCT and ASRH services.
• Interventions should support sensitization of health workers on integrated
SRH/FP/HIV services.
EmONC services
The provision of BEmONC services were generally average, ranging between
3.4% for Assisted Vaginal Delivery to 89.7% for the administration of
Uterotonic Drugs. It is therefore important to scale up the provision of
BEmONC services through advocacy for a policy on EmONC services, and
support for training and supplies, equipment and drugs. It is expected that the
health system strengthening initiatives of UNFPA will enhance the provision of
this BEmONC services.
Collect and analyse data on the provision of New Born Care services.
Advocate for policy to sustain high rate of the provision CEmONC services at
27.6% for blood transfusion and to scale up the provision of CS services at
3.4%.
Strengthen the referral system to enable the supported facilities to attend to
the large number of obstetric complications at 405; by sustaining availability of
referral forms at 100 and ensuring utilization of referral forms at 34.5%. No
reasons was given for the low level of utilisation of available referral forms.
Ensure the provision of birth-preparedness care services by all the supported
facilities due to the fact that 79.5% including none of the PHCs; did not
provide the services.
Ensure that 79.3% of the facilities that do not have functional means of
transport at the moment, were provided functional means of transport. The
existing functional means of transport in the 20.7% of the facilities should be
sustained. Also advocate public-private or public-community partnership in the
provision and maintenance of functional means of transport.
Ensure availability and functionality of delivery beds, especially in the Primary
facilities and in the rural facilities.
Collect and analyse data on essential drugs, equipment and consumables to
strengthen EmONC services.
Scale up the use of autoclaving at less than 10% as a method of sterilization
in view of HIV/AIDS and emerging diseases, and to eliminate the complicities
in the use of boiling and disinfection as methods of sterilization by health
workers.
Data collection, supervision and community management
• Ensure availability and utilization of RH/FP data collection forms, since just a
little more than half (55.2%) of the facilities had RH/FP data form. Also
encourage the high rate of utilization of available RH/FP data forms; and
support the implementation of the NHMIS forms
• Other statistical data collection forms were available in 82.8% of the facilities.
Interventions should sustain this high percentage and encourage the balance
69

of 17.2% that did not have to obtain and use these other statistical data
collection forms.
• Sensitise health workers on the submission of collated RH/FP/HIV data forms
to LGA M&E officers.
• IEC materials were reported to be available on only Malaria and Immunisation
in some of the facilities. Hence, ensure availability of IEC materials on UNFPA
mandate areas in all the supported health facilities to enhance awareness
about RH/FP/HIV services.
• Ensure timely visits to facilities by LGAs
• Sustain availability of functional VHCs in the 19 facilities (65.5%), out of the
16 facilities (84.2%) were functional. Also, ensure availability and sustenance
of functional VHCs in the remaining 34.5% of the supported facilities that did
not have any VHC, with a view to support demand creation and facility
strengthening efforts.
70

5. REFERENCES
71

6. APPENDIX 1
Frequencies
72