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Health Facility Assessment Report How Prepared Is Our Healthcare System for the COVID-19 Pandemic? May 2020 Health Facility

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Health Facility Assessment Report How Prepared Is Our Healthcare System for the COVID-19 Pandemic? May 2020 Health Facility Health Facility Assessment Report How prepared is our healthcare system for the COVID-19 pandemic? May 2020 Health Facility Assessment Report How prepared is our healthcare system for the COVID-19 pandemic? May, 2020 2 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? Authors: This document was developed by Christian Aid with funds from UK aid from the UK government. Acknowledgements: A very big thank you to all our implementing partners who supported in the data collection process. We appreciate the members of the MEAL team who supervised the entire process and ensured the data was appropriately managed. Thank you for your expert advice. Christian Aid is a Christian organisation that insists the world can and must be swiftly changed to one where everyone can live a full life, free from poverty. We work globally for profound change that eradicates the causes of poverty, striving to achieve equality, dignity and freedom for all, regardless of faith or nationality. We are part of a wider movement for social justice. We provide urgent, practical and effective assistance where need is great, tackling the effects of poverty as well as its root causes. christianaid.org.uk/nigeria Contact us Christian Aid Nigeria Country Office Plot 802, Off Ebitu Ukiwe Street Jabi District Abuja, FCT Nigeria T: +234 (0) 703 255 9282 E: [email protected] W: christianaid.org.uk/nigeria UK registered charity no. 1105851 Company no. 5171525 Scot charity no. SC039150 NI charity no. XR94639 Company no. NI059154 ROI charity no. CHY 6998 Company no. 426928 The Christian Aid name and logo are trademarks of Christian Aid © Christian Aid May, 2020 Christian Aid is registered with the National Planning Commission of Nigeria. Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 3 Contents Executive summary 5 Introduction 6 Purpose of the assessment 6 Objective of the Assessment 7 Methodology 8 Scope of the Assessment 8 Type of Health Facilities 8 Areas covered within health facilities 8 Sample size 8 Data Collection Instruments 8 Training and field strategy 9 Training of data collection teams 9 Fieldwork Strategy 9 Quality Assurance 9 Data Analysis 10 Constraints and limitations 10 Data management 10 Key findings 11 Availability of Bed spaces 11 Type of facilities and services provided 11 Health Workers and their distribution 12 Health Workers trained on National COVID 19 Protocol and Guidelines 13 COVID 19 case management and facilities for Infection Control 13 Recommendations 15 Annex 17 Cover: Data collection at Health facility assessment in Ihugh Primary Health Care, Vandeikya LGA, Benue State Photographs: Christian Aid 4 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? List of Acronyms CA Christian Aid CLHEI Community Links and Human Empowerment Initiative COVI9 19 Corona Virus Disease of 2019 DFID The United Kingdom Department for International Development EYN Ekklisiyar Yan’Uwa ‘a Nigeria (Church of the Brethren in Nigeria) HFA Health Facility Assessment IDP Internally Displaced Persons LANW Legal Awareness for Nigerian Women LGA Local Government Area MCHC Maternal and Child Health Centres MVF Mercy Vincent Foundation PHC Primary Health Centres PPEs Personal Protection Equipment UNICEF United Nations Children Fund SOPs Standard Operating Procedures WHO World Health Organisation Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 5 Executive summary As part of the response to the COVID-19 outbreak, Christian Aid Nigeria is responding to a DFID call for proposal to support preparedness and response to primary and secondary impacts of COVID-19 on the most vulnerable individuals and communities. This requires series of proven and cost-effective measures for saving the lives of IDPs, Returnees and vulnerable populations in hard to reach areas of Benue, Borno and Kaduna states of Nigeria. This is a five-month project funded by DFID and being implemented by Christian Aid Nigeria and Afghanistan through local partners. In Nigeria the intervention is implemented by a local consortium led by Christian Aid Nigeria and four local partners: Mercy Vincent Foundation (MVF) and Ekklisiyar Yan’Uwa ‘a Nigeria (Church of the Brethren in Nigeria) leading project activities in Borno state, Legal Awareness for Nigerian Women (LANW) is leading activities in Kaduna state while Community Links and Human Empowerment Initiative (CLHEI) is responsible for Benue state. Existing health care delivery system both in the public and private sectors were assessed through a survey labelled Health Facilities Assessment (HFA). This survey was conducted by Christian Aid partners and led by Christian Aid Nigeria in three states across 12 Local Government Areas (LGAs). The objective of the survey was to assess the existing health services profile, physical infrastructure, equipment/supplies, human resources, auxiliary services and quality of health services been rendered to the communities. Standardised questionnaires scripted into kobocollect mobile applications was used to collect quantitative data at the community level (a total of 56 health facilities across the three states were assessed and a total of 1308 health personnel across the three states’ LGAs were interviewed directly to sample their opinion and perception of the Covid-19 pandemic and also about their knowledge of this pandemic. Data was analyzed using Power BI application and frequency tables were generated community wise by type of health facilities. Standard ethical considerations for conducting research were adhered to strictly, especially those dealing with confidentiality of study participants and respect for socio-cultural systems and structures. The health facility assessment has revealed that: The study covered 56 health facilities across 12 LGAs in Benue, Borno and Kaduna states. These 56 facilities have a combined total of 642 bed spaces to serve the health need of an estimated 2,826,379 persons in 3397 communities, this falls short of WHO’s 5 bed spaces to every 1000 population recommendation The dormant service types available in the accessed facilities is clinical services, as 66.27% of the target facilities render clinical services, 25.30% of them render Pyscho-social support and the remaining 8.43% render other forms of health services. There are a total of 1308 staff across all 56 health facilities assessed with 491 females representing 37.54% of the total work force who are full time health workers, 26.91% (352) are full time male workers, the other 465 are part time health workers and volunteer staff. Of these, 227 are volunteers comprising of 119 females. With 1308 health workers across the target health facilities, only 207 have been trained on COVID-19 national protocol. Kaduna state contributes the highest number of trained health workers with 104 trained staff, 65 of these staff are concentrated in one LGA of the state – Markafi LGA. In Benue state, across all 4 LGAs only 26 Health workers have been trained on COVID-19 national protocol while in Borno state 78 health workers have benefitted from the trainings on COVID 19 protocol 6 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 98.21% of the health workers interviewed attest that they are aware of COVID-19 and only 2.79% said they were not aware of the global pandemic. The respondents also revealed that most of the trainings on Covid-19 were facilitated by the various state government through the state ministry of health with WHO and UNICEF being the second highest providers of COVID 19 trainings to health workers. Basic and/or Comprehensive Emergency Care Services on Covid-19 are not available in some of the surveyed health facilities. Underlying reasons are non-availability of service delivery protocols/guidelines, inadequate human resources, lack of facilities for infection control such as hand washing facilities for all staff and patients, gloves, adequate ventilation, safe distancing for patients and waste disposal. Keeping in mind the findings revealed through this Health Facility Assessment, certain interventions are required to improve the prevention of Covid-19 pandemic at both the primary health facilities and the public/comprehensive health centres across the target LGAs. The availability of basic and comprehensive Covid-19 Emergency Standard Operating Procedures must be ensured at appropriate levels of health care centres at all community level. All Covid- 19 related posts should be occupied at all health centres and protocols/guidelines should be shared with these facilities. Availability of all physical resources and essential Covid-19 supplies including face masks/Personal Protective Equipment supply must be ensured at all levels and mechanism outlined for their regular maintenance. Testing centres and/or laboratory services should be made available. Public health centres facilities should also be strengthened in this regard. See the Full Report of the HFA for more details. Introduction The global COVID 19 pandemic have impacted heavily on vulnerable communities in Nigeria, the impact of this pandemic further worsens already depleted access to essential health services in Nigeria. To support health facilities in dealing with the increasing pressure on health service delivery following the COVID 19 outbreak in Nigeria and ensure that target communities continue to have
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