Other Projects Implemented

The introductory advocacy visits to relevant stakeholders earned the project the opportunity to make a case that supported the course of influencing people to support the Enhancing Citizens’ Access to Effective Primary Health Care Services Project. It was an avenue to introduce the project and the implementing team to relevant stakeholders, and raised the profile of the project before the relevant stakeholders within the sector. It enabled the implementing team to gather and organize information that was necessary for the successful implementation of the project and made both state and non-state actors understand the project and its scope, as well as their buy-in. Furthermore, the activity raised awareness and influenced duty-bearers/decision makers at various levels of the sector to embrace, support, and key into the project across the state. This activity was an entry point after proper analysis of the stakeholders, most especially the primary healthcare administrative base across 7 LGAs of Uyo, Onna, Oron, Ibesikpo-Asutan, Obot-Akara, Itu, and Ikono, LGA Chairpersons, Community Leaders and influencers, State Ministry of Health, and Local Government Service Commission in Akwa-Ibom State. Therefore, the commitment and buy-in of stakeholders were obtained, thereby enabling the smooth implementation of the project.

The Ward Development Committee was an initiative of the National Primary Health Care Development Agency (NPHCDA), designed to strengthen local communities to advocate for them in terms of knowledge dissemination of health information with cognizance of the socio-cultural context in which health actions are being taken. It provides information to villagers that assists them to take control over their own lives, change their risky health practices, contributes to activities for community health improvement programs, reduces conflict of interest, enhances credibility and cooperation among members, and ensures greater acceptance of new novel ideas and aids utilization and sustainability of health care services at the grassroots. Therefore, this activity was used to constitute the WHDC, that consist of four (4) representatives each from selected 35 communities’ PHCs, i.e., 5 communities each across 7 LGAs of Akwa Ibom State, giving 20 WHDC Members per LGA with a total of 140 across the entire 7 LGAs. The membership was drawn from the Community leadership structure, Youth Wing, Women Wing, and the PHCs. Upon the selection, they were sensitized, stating their roles and responsibilities, and thereafter inaugurated.

The essence of this activity was to assess the physical and financial gaps between needs and resources available for the PHCs, create awareness among beneficiaries and providers of local, social and productive services, increasing efficacy and effectiveness of local development programme; scrutinizing various policy decisions, keeping in view stakeholder interests and priorities, particularly of rural poor and estimation of the opportunity cost for stakeholders of not getting timely access to public services. The activity was used to understand the state of the PHCs within the selected 35 PHCs across the 7 LGAs of intervention. The indicators that were looked at were furniture, equipment, infrastructure, PHC staffing, drugs, staff welfare, and training. Also, service indicators were scored too, which include affordability, availability, accessibility, attitude of PHC staff, and patronage. The result of the scorecard showed that the PHCs in Akwa Ibom lack basic furniture, especially chairs. Where they are available, they are not suitable for pregnant women, such as benches. Basic equipment for the day-to-day running of the PHCs is lacking; there are no drugs at the PHCs apart from anti-malaria drugs, with an average of 2 staff at most of the PHCs, making them unable to run a shift. However, in terms of infrastructure and staff salary, the state was rated high as the OICs confirmed that their salaries are paid as due. In line with PHCs services, it was discovered that it was highly affordable, especially delivery, when compared with traditional birth attendants whose charges are 5 times that of the PHCs. Patronage was somewhat low as a result of the unavailability of OICs during the night due to a lack of enough staff to run the shift and the attitude of some of the OICs. The findings of the scorecard were critical information for advocacy for desired change.

The essence of this activity was to assess the physical and financial gaps between needs and resources available for the PHCs, create awareness among beneficiaries and providers of local, social and productive services, increasing efficacy and effectiveness of local development programme; scrutinizing various policy decisions, keeping in view stakeholder interests and priorities, particularly of rural poor and estimation of the opportunity cost for stakeholders of not getting timely access to public services. The activity was used to understand the state of the PHCs within the selected 35 PHCs across the 7 LGAs of intervention. The indicators that were looked at were furniture, equipment, infrastructure, PHC staffing, drugs, staff welfare, and training. Also, service indicators were scored too, which include affordability, availability, accessibility, attitude of PHC staff, and patronage. The result of the scorecard showed that the PHCs in Akwa Ibom lack basic furniture, especially chairs. Where they are available, they are not suitable for pregnant women, such as benches. Basic equipment for the day-to-day running of the PHCs is lacking; there are no drugs at the PHCs apart from anti-malaria drugs, with an Upon generating the information on the state of the PHCs in Akwa Ibom state, there was a need for both state and non-state actors to sit and validate the findings. This is to make the report of the scorecard a working document for the state and enable state actors (duty bearers) who were not part of the exercise but saddled with the responsibilities of providing health services to citizens to make inputs on the findings. Prominent at the meeting were the Executive Secretary of the AKSPHCDA, the Permanent Secretary of the State Ministry of Health, the Director of Public Health, OICs, and WHDC members. In conclusion, stakeholders validated the report and accepted it as a working document in the state, as the stakeholders corroborated the findings of the scorecard, while the government representatives presented the ongoing efforts of the government to address issues raised, as well as constraints. The OICs and WHDC all appreciated the opportunity to interact personally with key government officials and took that opportunity to call attention to specific needs in their PHCs. Some WHDC member also highlighted their efforts in mobilizing support for their PHCs. It was agreed by all that more advocacy is needed to the relevant authorities to improve the health sector funding, in order to address the gaps.

The PHC challenges are enormous, ranging from low funding to staff inadequacy, decaying infrastructure, dilapidated facilities, furniture, basic equipment, essential drugs, inadequate staff /no staff quarters, and low patronage. The consequences of these have hampered successful health services delivery to the people at their point of need, with a severe negative impact on the citizens, especially the rural poor. As a way of bringing state and non-state actors to speed on the state of the PHCs, the validated report findings were used to engage stakeholders in the first advocacy carried out in the project, where commitments were secured. Therefore, the second advocacy visit was tailored to ascertain the level of compliance with the documented commitments and also engage them on the emerging issues that ensued thereafter. The activity was a continuous effort to influence and reawaken stakeholders and spur them to action in their lines of duty as citizens towards achieving effective health service delivery across the piloted 7 LGAs and the state at large. The actors visited are the Hon. Commissioner for Health, Chairpersons/representatives of the LGC, Executive Secretary of the AKSPHCDA, Director of Health, LGSC, and community leaders/heads.

The training of stakeholders on advocacy, voice, power, budget, and Accountability was in two phases. The first phase was ToT, and the second was step-down training of stakeholders. It was a critical activity that built the capacity of the critical stakeholders of the project, particularly the WHDCs. The training on voice made it clear to participants that it is difficult, if not impossible, to influence society unless your voice is represented in political processes and encouraged them to organize, mobilize, identify stakeholders for alliance building, and form a cluster/group for effective engagement. That of power made it clear that a society cannot be changed without having power and influence. For voice to be heard and demands for change to be taken seriously, political power is needed. The training presented tools for analyzing power and practical strategies for participants to maneuver and negotiate through the webs of hidden power towards more inclusive people-centered development. Participants understood the importance of the budget as the second most important economic policy document of a nation or a State. Indicating the fiscal representation of a government’s plans and goals, and a statement of the annual expected revenue and expenditure. The training made participants recognize the political and economic dimensions of the budget and enhanced their skills to analyze the budget and engage duty bearers with their findings. Conclusively, the training on accountability taught participants how to be accountable for their roles and responsibilities, and the processes to hold anyone responsible to account for his/her stewardship.

The role of information, communication, and technology cannot be overemphasized in the twenty-first century. It is dominating all aspects of life and has the ability to fast-track development in its entirety. Therefore, to enable quick communication of actionable information about PHC services within the pilot LGAs in the state, the need for the IVR. The IVR is a web-based platform that enables information, especially voice messages, to be disseminated to the targeted audience and get their feedback as well. The IVR was created and uploaded with relevant health information that will be easily accessible to anyone while enhancing the program implementation through feedback. The geographic information system map displayed the location of the 35 PHCs across the 7 LGAs for ease of location, while the chatbot facilitated discussion on the Facebook platform.

The quarterly monitoring and evaluation were carried out throughout the lifespan of the project. This was based on the role monitoring plays as a continuous process of assessing project activities in the context of implementation schedules and the use of project inputs for informed decision-making. It enabled the collection of data using a checklist on specified indicators to provide management with the level of implementation, indicating the extent of progress and achievement of objectives. The monitoring helped to identify shortcomings in achieving the intended objectives of the project. The identified problems were communicated to decision-makers for remedial actions. The activity also served as an opportunity to create awareness of the project and disseminate relevant information about the project.

This activity enabled the project to raise awareness and created wider visibility of the project to the general public, and enabled the reach of stakeholders who could not be reached physically. It also made information dissemination among the direct beneficiaries and the implementing partner easier and more cost-effective. This activity became necessary after the implementation of some critical activities in the project that needed the attention of the public, most especially the state actors, for actions to meet the project objectives and inputs that would improve project planning and implementation. This activity’s engagement strategy was a physical visit to Inspiration FM Radio Station and the Akwa Ibom Broadcasting Corporation.  Contacts of the implementing partner were disseminated to the general public for further engagement on the project. On the other hand, the project created WhatsApp, Facebook, and Twitter platforms where information about the project was disseminated and feedback was obtained, thereby bridging the communication gap. An advocacy song was also produced and used as a jingle on the radio and IVR platform.

The WHDC activity was used to generate and collate information gathered by the WHDCs during their previous meetings and engagement, and share relevant information capable of enhancing their knowledge on possible ways of improving their PHCs. In addition, the activity created space for WHDC members to learn best practices from others while taking steps to address some of their challenges through advocacy. The activity enabled community members to build a critical mass movement of voice to engage duty bearers and demand their entitled rights and change the wrongs. It was also to ascertain their effectiveness and relevance to the primary healthcare sector, considering their involvement in the PHCs’ activities and the outcomes of their engagement. Furthermore, the outcome of the support meeting was used for planning, sustainability, and mainstreaming the project to stakeholders and communities across the LGAs, while also helping to identify shortcomings in achieving the intended objectives of the project. The identified problems were then communicated to decision-makers for remedial actions.

Closeout is the process and practice of finalizing, making sure that all activities and deliverables planned for the project were completed in the planned sites, keeping community members and stakeholders who participated in the project implementation abreast of the project exit, and preparing them to carry forward the management and sustainability of the project upon its exit. The process provides the space for partners to discuss observations and challenges of the project with the community members and other stakeholders to develop work plans that would follow actions and recommendations for sustainability. Again, the activity helped to identify improvements and/or best practices that would be applied to future project planning and implementation for both partners and beneficiaries. It ensured that community members documented the outcomes, challenges, and processes of the projects properly for future reference and learning.