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 access to basic health services, a component of the DIFID COVID 19 RRF has strategically targeted health facilities and health workers in target LGAs for COVID 19 related support.

This document is a report of the needs assessment study in Benue, Borno and Kaduna states among facility health workers and physical assessment of health facilities in the target communities. It is intended that this report will guide the development of humanitarian intervention in these locations, and the information in this report will be used by stakeholders, government and other humanitarian actors in addressing the critical needs of primary and secondary impacts of COVID-19 on IDPs, Returnees and vulnerable populations in hard to reach areas of Nigeria target states.

Purpose of the assessment The purpose of this assessment was to generate information for the Localised preparedness and response to primary and secondary impacts of COVID-19 on IDPs, Returnees and vulnerable populations in hard to reach Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 7

areas of Nigeria. The outcome of the survey will enable Christian Aid Nigeria (CAN) and the government to reposition health care system in the public sector and coordinate with the private sector while taking advantage of the ideal opportunities offered by this project. Christian Aid’s response on the Covid-19 intervention is basically an effort to establish benchmarks for setting targets, devising strategies and plans to achieve the project objectives.

Objective of the Assessment Overall, the objective of the survey was to describe the availability, functioning and quality of health care delivery system in the public and private sector of the selected target of intervention with focus on Covid-19 response services. The specific objectives of the survey are:

1. To evaluate the availability of various service packages especially for Covid-19 pandemic.

2. To assess the availability of resources and provision of the health care services to the indicated target groups in project areas.

3. To recognize/identify gaps in the processes and quality of care related to Covid-19 services provided at public and private health facilities.

4. To depict some basic issues concerning provider-client interactions taking place in the health care facilities in the project communities.

5. To evaluate the essential support services for optimal functioning of the health care delivery system on Covid- 19 in target communities.

8 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

Methodology

Design: The survey was based on general observation, examination of facility records, and interviews with facility personnel. A cross sectional quantitative study was conducted, and data collection was done using structured questionnaires

Scope of the Assessment The assessment was conducted in three states (Benue, Borno and Kaduna) across 12 LGAs in 54 communities.

Type of Health Facilities  Primary Health Centres (PHC)

 Reproductive Health Services Centre

 Basic Health Units

 Maternal & Child Health Centres (MCHC)

 Private Hospitals

 Maternity Homes

Areas covered within health facilities  Essential support services such as laboratory, doctors’ consulting rooms and ambulance services

 Facility management support; such as facility environment, waste disposal, service delivery, guidelines and referral system.

Sample size A total of 53 health facilities were targeted, their distribution according to location is provided in the annex.

Data Collection Instruments The study was conducted using structured Standardised questionnaires scripted into Kobocollect mobile applications for the collection of quantitative data at the community level (a total of 13408 individuals where directly interviewed).

The instruments for the needs’ assessment was designed by Christian Aid’s MEAL unit with inputs from Christian Aid’s implementing partners. This was again critically reviewed by Christian Aid’s technical programme team to ascertain the comprehensiveness of the tool before deployment on the field for the training of enumerators and data collection. During the training of enumerators in the three programme states, the instrument was reviewed again by the trained enumerators to test run the tool.

Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 9

Training and field strategy

Training of data collection teams The training of the enumerators for the collection of data was done per state. This was carried out by Christian Aid trained staff and all 4 local partners involved in this intervention. With the support of Christian Aid MEAL staff, partner trained staff were properly guided to ensure that they receive the same quality of training on the tool before they finally move into the field for the data collection exercise. Across the three states, 94 enumerators and 4 supervisors (1 per partner organisation) were trained on 10th of May 2020 on the use of the scripted Kobo questionnaire and were further trained on how to handle the mobile data collection system and Mobile Data Collection Devices.

The objective of the training was to give the enumerators a general overview of the study “Facility Assessment” in Benue, Borno and Kaduna States. The questionnaire guide was also clarified with key emphasis on content understanding for the instrument, data quality and interview management and other necessary procedures to be adhered to during field work.

Fieldwork Strategy There was wide variation in terms of size and complexity of the facilities to be surveyed. In order to make best use of resources, the following field work strategy was implemented.

– A total of 3 teams- one team per state were organized for the entire fieldwork. Each team comprised of average of 12 members depending upon the size of the sample in district. Each team was headed by a team leader who was responsible for quality assurance of data collection and overall coordination of team in the field.

– Before starting the field work, meetings were held with community heads for seeking support and facilitation. There were no recorded issues relating to non-cooperation of the facility staff.

– Prior notice was sent to community heads and facility to be surveyed indicating time and date for the visit of the team.

– The teams visited facilities on working days only and visits on off days were normally avoided unless there was a specific appointment with the facility in-charge.

– Full team worked for an average of 6 days to collect data from community target communities

– The teams were required to follow the detailed Field Work Plan at all costs. The facilities that were not covered according to the plan were postponed to the end of the survey ensuring that the Field Work Plan was not disturbed due to problem at few sites.

Quality Assurance Key measures for quality assurance of data were:

 Survey instruments were extensively reviewed by both partners and CA technical staff before finalization.

 Intensive training was imparted to the survey teams, which was followed by careful and effective supervision by CA team during field work.

10 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

 Team leaders edited questionnaires on site and referred mistakes to the enumerators for correction/ clarification. This field editing ensured completeness of the questionnaire and correction of mistakes/ inconsistencies.

 To further strengthen the quality assurance mechanism, supervisors from CA accompanied enumerators to the field. The supervisors used a standard checklist to ensure uniformity of the supervision process. The feedback received through supervisory visits was extensively discussed among CA staff/partners and immediate steps were taken to implement identified actions.

 All questionnaires received from the field were edited and coded by trained CA staff before data entry

Data Analysis Data collection was done using Kobo collect and analysed with the Microsoft Power BI application. The data was analysed by type of the health facilities and by community with focus on predefined indicators.

Constraints and limitations

All efforts were made to minimize the systematic errors in design phase, data collection and analysis but still there were certain inherent constraints and limitations in survey which are summarized below:

 As the scope of survey was broad, therefore a combination of methodologies was inevitable, and few compromises had to be made in this balancing exercise.

 In health care delivery system diverse types of services are delivered through multiple mutually interacting and coordinating systems of auxiliary and support services. These services are managed in the same premises and under the same management resulting in complexity of need assessment for a specified area of intervention.

 Scope for aggregate analysis was limited as the survey was conducted in 12 local government areas across our 3 target states purposely selected communities and analysis of the results may not be taken as representative of respective states or the country as a whole.

 Data collection in the survey was highly dependent on facilities available within the communities, therefore the results should be interpreted with caution.

Data management

The data for the Facility Assessment was collected using Kobo Collect). In the course of the field work, we carried out spot checks of interviews done - to ensure data quality assurance and at the end of every day’ fieldwork questionnaires were uploaded to the Christian Aid MEAL Kobo platform by the enumerators and retrieved by CA MEAL unit for collation and review.

Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 11

Key findings

The summary findings for this Health Facility Assessment are findings from the quantitative surveys and additional evidence from the physical observations.

Availability of Bed spaces A total of 56 facilities where visited during this assessment, the facilities covered are spread across 12 LGAs in 3 states. They include Agatu, Vandeikya, Kwande and Oju in Benue state, Dikwa, Jere, Konduga and Maiduguri LGAs of Borno state and Kachia, Kajuru, Kaura and Markafi LGAs of Kaduna state. Theses 56 health facilities serves 3,397 communities with an estimated total number of 2,826,379 persons across all the states. The total number of bed spaces available across the selected facilities stands at meagre 647 beds spaces as against 972 bed spaces by the original design of these facilities leaving a deficit of 324 bed spaces.

Type of facilities and services provided 83% of the facilities accessed were primary health Centers, 14% were secondary health facilities and only 3% were Health Post. All 4 Health post that made up the 3% of sampled health facilities are located in Kaduna state, none of the target communities in Benue and Borno states have a Health post.

The dormant service types available in the targeted facilities is Clinical services, as shown in the findings 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.

12 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

Health Workers and their distribution The survey revealed that there is a total of 1,308 staff across all 56 health facilities covered by this assessment. Of these number, 491 represents 37.54% of the total work force as full-time female health workers, 26.91% (352) are full time male workers, the rest 465 are part time health workers and volunteer staff. Of these figures, 227 are volunteers comprising of 119 females

Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 13

Health Workers trained on National COVID 19 Protocol and Guidelines Of the 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 trainings on COVID 19 protocol. Despite the very low number of trained health workers about 98.21% of them said they are aware of COVID-19 and only 2.79% said they were not aware of the global pandemic. Most of these trainings were facilitated by the state government through their state ministry of health with the WHO and UNICEF being the second higher providers of COVID 19 trainings to health workers.

Of the 3 states accessed facilities, Kaduna state proved to have the highest capacity for contact tracing with a percentage of 61.54 %, in Borno state, this stood at 33.33% while Benue state had the least capacity for contact tracing at 11.11%. In total only 29.09% of target facilities affirmed that they have capacity for contact tracing the other 70.91% reported otherwise.

COVID 19 case management and facilities for Infection Control 75% of the facilities visited said they have facilities for infection control including access to handwashing facilities for all staff and patients, hand gloves, face masks, waste disposal, adequate ventilation, safe spacing etc. 76.92% of facilities in Kaduna have facilities for infection control, in Borno state, 93.75% of facilities have infection control measures while in Benue only 62.9% of facilities have facilities for infection control in place. Only 13 of all 56 facilities representing 23.64% of facilities responded in affirmative when asked if they have an SOP in place for guiding their daily operations, the other 76.36% do not have any SOP in place. Considering the very infectious nature of the COVID 19 pandemic, this percentages are quite low and worrying.

14 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

82.14% of selected facilities do not have PPEs for health workers, in total there are only 84 PPEs for 843 full time health workers across 56 facilities in Benue, Borno and Kaduna states. There are only 2 for facilities in Kaduna states (in Markafi LGA) 5 for facilities in Benue state while the remaining 77 PPEs where recorded for facilities in Borno state.

Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 15

Recommendations

The true impact of a COVID-19 outbreak in our target communities cannot be predicted. However, all healthcare facilities can take steps now to prepare for such an outbreak and protect both their patients, staff and the communities at large.

Provision of PPEs: Findings from this assessment has shown that a staggering 82.14% of Health workers across selected facilities do not have PPEs. According to reports from various studies on COVID 19, (www.who.int) the coronavirus can remain stable on surfaces for several hours, these include surfaces like plastic and stainless steel which are very common items within a health facility. This puts health workers at a high risk of rubbing off these surfaces with their hands and equipment which becomes very dangerous to them and the patients they serve. As such it becomes very important that health facilities are provided with adequate PPEs especially basics like face masks, surgical gloves, disinfectants, surgical gowns etc. Some ways to do these is to:

1. Ensure Health workers are well-trained on the use of personal protective equipment (PPE).

2. Educate community members/train health personnel staff on COVID-19 and what they may need to do to prepare. The following may be useful to share information about COVID-19:

a. How COVID-19 spreads

b. Clinical management of COVID-19 patients

c. Infection prevention and control recommendations for COVID-19

Training on COVID 19 National Protocol: With guidance from the WHO a national protocol has been developed to guide health facilities in managing COVID 19 cases, these includes understanding of the symptoms of the diseases, facilitating isolation of cases and referrals to designated COVID 19 treatment centres. This is to mitigate the spread of the disease while ensuring that communities still have access to safe and quality health services. However, from this assessment we have seen that out of the 1308 health workers across the target health facilities only 207 are trained on COVID-19 national protocol and guidelines, as such it becomes a major need across all 3 states, it must be prioritized for certain states and locations. for example, in Benue state only 14.81% of the health workers have been trained on COVID 19 protocol, while Kaduna and Borno records a fairly impressive percentage of trained staff on COVID 19 protocol (92.31% and 75% respectively) the same cannot be said of all the target locations within the states. In Kaduna state, all 3 of the LGAs have a 100% record of trained staff but Kaur LGA still has only 66% of health workers trained on the COVID protocol.

Adoption of COVID 19 SOPs across all facilities: SOPs are tools for standardising operations across facilities for quality assurance control. However, in this assessment only 23.64% of targeted facilities have adopted an SOP for managing COVID 19 cases and other services provided within the facilities. It becomes very important for this intervention to support facilities in developing or adopting SOPs to help ensure that guidance for managing cases are adhered to as well ensure quality service to community members.

16 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

Need for more Full-time Health Facilities and workers in target communities: This study has revealed that an estimated 2,826,379 persons across all the communities relies on 56 health facilities for their health needs. These 56 facilities only have 647 beds spaces and 843 full time health workers. This already puts pressure on the health system without considering the impact of COVID 19 which will further deplete the access to and quality of health services available to communities as we have already seen globally, which is evidently worse in poor countries like Nigeria. Following this it becomes necessary that this intervention upskill the capacity of communities to engage with the state to provide more health facilities, scale up existing facilities and engage more health workers to address any gap that might constitute a hindrance to health services for community members.

Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 17

Annex

Table 1: List and Location of target Facilities SN Name of Facility Type of Facility Name of Name of LGA State community 1 Maternal and Neonatal Child Primary Health Afunori/kamcheji Dikwa Borno Health Facility 2 Bakassi Clinic A Primary Health Abakarti Maiduguri Borno Facility 3 Bulabulin dispensary Primary Health Biafra Maiduguri Borno Facility 4 Gwange Primary Health Care Primary Health Biafra Maiduguri Borno center Facility 5 Dikwa secondary Healthcare Secondary Health Kanumburi Dikwa Borno Facility 6 Bulabulin lima ngarannam Bolori Primary Health Bolori 2 Maiduguri Borno 2 PHC Facility 7 1000 Shelter Clinic Primary Health Mogulanda Dikwa Borno Facility 8 Shehu Masta Camp Primary Health shuwari Dikwa Borno Facility 9 SNEPCO IHAP + Primary Health Motor pack/Bulabulin Dikwa Borno Facility 10 Intersos Primary Health Care Primary Health Bulabulin Dikwa Borno Bulabulin Facility 11 Gongulong Comprehensive Primary Health Gongulong Jere Borno Health Center Facility 12 Dalaram PHC Primary Health Filinball Jere Borno Facility 13 Dalori Health Clinic Primary Health Dalori Konduga Borno Facility 14 777 Housing Estate Clinic Primary Health Moronti Konduga Borno Facility 15 Njimtilo Primary Health Care Primary Health Njimtilo Konduga Borno Center Facility 16 1000 Estate Clinic Primary Health Moronti Konduga Borno Facility 17 General Hospital Obagaji Secondary Health Obagaji Agatu Benue Facility 18 Comprehensive Health Centre Primary Health Obagaji Agatu Benue Obagaji Facility 19 Primary Health Centre Obagaji Primary Health Obagaji Agatu Benue Facility 20 Primary Health Centre Odugbeho Primary Health Odugbeho Agatu Benue Facility 21 Primary Health Centre Ogwule Primary Health Ogwule Ogbaulu Agatu Benue Ogbaulu Facility 22 Primary Health Centre Usha Primary Health Usha Agatu Benue Facility 23 Ggeneral Hospital Adikpo Secondary Health Adikpo Kwande Benue Facility 24 Gabriel Suswam Cottage PHC Primary Health Adikpo Kwande Benue Facility 25 Primary Health Centre, Ikyogen Primary Health Ikyogen Kwande Benue Facility

18 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

SN Name of Facility Type of Facility Name of Name of LGA State community 26 Primary Health Centre, Jato Aka Primary Health Jato Aka Kwande Benue Facility 27 Primary Health Centre, Koti Primary Health Koti Kwande Benue Facility 28 Primary Health Centre, Mbachon Primary Health Mbachon Kwande Benue Facility 29 Primary Health Centre township Primary Health Adikpo town Kwande Benue Adikpo Facility 30 Primary Health Centre,Agenogo Primary Health Agenogo Kwande Benue Facility 31 General Hospital Oju Secondary Health Oju Oju Benue Facility 32 Primary Health Centre, Igede Primary Health Oju Oju Benue Centre Oju Facility 33 Primary Health Centre, Amenka Primary Health Amenka Oju Benue Facility 34 Primary Health Centre, Obusa Primary Health Obusa Oju Benue Facility 35 Primary Health Centre, Oboru Primary Health Oboru Oju Benue Facility 36 General Hospital Vandekya Secondary Health Vandekya Vandekya Benue Facility 37 Maternal and child health clinic Primary Health Vandekya Vandekya Benue Vandekya Facility 38 Primary Health care Centre, Primary Health Vandekya Vandekya Benue Vandekya town Facility 39 Modern Primary Health Care, Primary Health Tsar Vandekya Benue Tsar Facility 40 Primary Health Care Tsar Primary Health Tsar Vandekya Benue Facility 41 Primary Health Care Ihugh Primary Health Ihugh Vandekya Benue Facility 42 Primary Health Care Imoughun Primary Health Koti yough Vandekya Benue Facility 43 Primary Health Facility Awon Primary Health Awon Kachia LGA Kaduna Facility 44 Primary Health Facility Ankwa Primary Health Ankwa Kachia LGA Kaduna Facility 45 Health Post Kwaturu Health Post Kwaturu Kachia LGA Kaduna 46 Health Post Galadanchi Health Post Galadanchi. Kachia LGA Kaduna 47 Primary Health Facility Damisa Primary Health Damisa, Makarfi Kaduna Facility 48 Primary Health Facility Gazara Primary Health Gazara, Makarfi Kaduna Facility 49 Primary Health Facility Gubuchi Primary Health Gubuchi Makarfi Kaduna Facility 50 Primary Health Facility Tudun Primary Health Tudun Wada. Makarfi Kaduna Wada Facility 51 Secondary Health Facility Tudun Secondary Health Tudun Wada Makarfi Kaduna Wada Facility 52 Primary Health Facility Kallah Primary Health Kallah Kajuru Kaduna Facility 53 Primary Health Facility Katura Primary Health Katura Kajuru Kaduna Facility Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic? 19

SN Name of Facility Type of Facility Name of Name of LGA State community 54 Primary Health Facility Rimau Primary Health Rimau Kajuru Kaduna Facility 55 Primary Health Facility Idon Primary Health Idon Hanya Kajuru Kaduna Hanya Facility 56 Primary Health Facility Manchok Primary Health Manchok Kaura Kaduna Facility 57 Primary Health Facility Zakan Primary Health Zakan. Kaura Kaduna Facility 58 Health Post Kukum daji Health Post Kukum daji Kaura Kaduna 59 Health Post Bondon Health Post Bondon Kaura Kaduna

20 Health Facility Assessment Report: How prepared is our healthcare system for the COVID-19 pandemic?

Contact us Christian Aid Nigeria Country Office Plot 802, Off Ebitu Ukiwe Street Jabi District Abuja, FCT Nigeria

+234 (0) 703 255 9282 [email protected] christianaid.org.uk/ngeria

England and Wales registered charity number. 1105851 Scotland charity number. SC039150 UK company number. 5171525 Registered with The Charity Commission for Northern Ireland NIC101631 Company number NI059154 Republic of Ireland Charity Commission number 20014162 Company number 426928. Christian Aid is registered with the National Planning Commission of NigeriaThe Christian Aid name and logo are trademarks of Christian Aid © Christian Aid August 2018