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w wI Trip Report 1 Travelers: Ms. Teresa lMrbito, IN7RAH Program Officer Country Visited: Kwara State, NICG.LA Date of Trip: November 11 - 12, 1986 Purpose: 1) To discuss with the MDH the present status and future plans for expansion of family planning service delivery and subsequent training requirements. 2) To observe members of the Kwara State Training Te;rm as they conducted the fifth Family Planning/Oral Rehydration Therapy workshoo with INTRAH financial support and without technical assistance 3) To discuss with the ..DII the plan to include two mnmbers of the Kwara State Training Team as co-trainers for the Lagos State FP/ORT/CHE Project to comi.ance January 1987. Program for International Training in Health 208 North Columbia Street The University of North Carolina Chapel Hill, North Carolina 27514 USA TABLE OF CONTENTS PAGE LIST OF ABBREVIATIONS EXECUTIVE SUMMARY . .. .. i SCHEDULE OF ACTIVITIES. .iii I. PURPOSES OF TRIP. 1 II. ACCOMPLISHMENTS . 1 III. BACKGROUND. .. 2 IV. DESCRIPTION OF ACTIVITIES. 2 V. FINDINGS AND CONCLUSIONS . 3 VI. RECOMMENDATIONS . 5 APPENDICES A. Persons Contacted/Met B. Kwara State Ministry of Health Family Planning Service: Quarterly Report July to September 1986 New Clients and Family Planning Methods C. Results of a Survey Conducted Under Supervision of Dr. 0. Fakeye, Chief, Obstetrics and Gynecology, University of Ilorin LIST OF ABBREVIATIONS CHE Community Health Education CS Child-Spacing LGA Local Government Area EXECUTIVE SUMMARY Ms. Teresa Mirabito, INTRAH Program Officer, visited Ilorin, Kwara State, November 11-12, 1986. The purposes of the trip were: (1) to discuss future plans for in-service training of family planning service providers in Kwara State; (2) to observe members of the Kwara State Training Team as they conducted a clinical service delivery skills workshop; and (3) to discuss with Ministry of Health officials the inclusion of two Kwara State Trainers on the training team for the INTRAH-sponsored Lagos State Ministry of Health Family Planning/Oral Rehydration Therapy/Community Health Education Training project to commence January 1987. Discussions were held with Mr. Saka Saadu, Permanent Secretary of Health; Dr. David Olubaniyi, Director of Health Services and Project Director; Mrs. Florence Tolushe, Family Planning Coordinator; and members of the training team: Mrs. Rachel Ajiboye, Mrs. Victoria Abodunrin, and Mrs. Grace Osunaiye. Present status and future plans for expansion of child spacing activities and plans for in-service training in Kwara State were reviewed. The Ministry of Health operates 70 health facilities which will all have at least two trained family planning service providers by the end of 1988. Fifty-three of these facilities currently offer family planning services and are staffed by one or two trained clinicians. In addition, it is anticipated that 90 Local Government Area facilities throughout the state will offer family planning services by the end of 1988. All health personnel will have been trained by members of the Kwara State Training Team. Three members of the State Training Team were observed as they conducted their fifth Family Planning/Oral Rehydration Therapy workshop. By the end of 1986 the team will have trained 87 nurse midwives in family planning -ii­ clinical skills and 21 community health assistants in family planning community health education and motivation. All training to date has been supported with funds from the Ministry of Health/INTRAH contract. The Ministry of Health is prepared to support fifty percent of the training costs over the next two years and is seeking support from other donors for the balance. Mr. Saadu agreed to release two Kwara State Trainers who will co-train in the Lagos State MOH FP/ORT/CHE training project. A need for training supervisors and community health educators and motivators was identified. Major recommendations include that INTRAH should provide support and technical assistance to the MOH for a Management and Supervision workshop for zonal supervision and a Community Health Education workshop for the community health aides. -iii- SCHEDULE OF ACTIVITIES Monday Arrived in Ilorin. November 10 Met with: Dr. David Olubaniyi, Director, Health Services, Ministry of Health, and Mrs. Florence Tolushe, State Family Planning Coordinator. Visited School of Nursing to observe members of the Kwara State Training Team conduct the fifth Family Planning/Oral Rehydration Therapy workshop. Met with members of the Kwara State Training Team: - Mrs. Victoria Abodunrin - Mrs. Rachel Ajiboye - Mrs. Grace Osunaiye Tuesday Met with Dr. Olubaniyi and Mrs. Tolushe. November 11 Met with Mr. Saka Saadu, Permanent Secretary, Ministry of Health, Kwara State. Attendees included Dr. Olubaniyi and Mrs. Tolushe. Visited: - University Teaching Hospital Family Planning Clinic - DHU Ilorin Family Planning Clinic - School of Nursing to observe Family Planning/Oral Rehydration Therapy workshop in progress Met with Dr. Olubaniyi. 3:00 p.m. Departed Ilorin for Lagos. 12:30 a.m. Departed Lagos for Paris. I. PURPOSES OF THE TRIP The purposes of the trip were to: 1) Discuss with the Ministry of Health the present status and future plans for expansion of family planning service delivery and subsequent training requirements. 2) Observe members of the Kwara State Training Team as they conducted the fifth Family Planning/Oral Rehydration Therapy workshop with INTRAH financial support and without technical assistance. 3) Discuss with the Ministry of Health the plan to include two members of the Kwara St,7te Training Team as co-trainers for the Lagos State FP/ORT/CHE Project to commence January 1987. II. ACCOMPLISHMENTS A) Reviewed plans for the CS program in Kwara State with the Director of Health Services/MOH/INTRAH Project Director and the Family Planning Coordinator. B) Visited the two family planning delivery points, one operated by the University of Ilorin Teaching Hospital and the second by the MOH. C) Observed three members of the Kwara State Training Team during the process of conducting an FP/ORT Service delivery skills workshop. D) Reviewed the FP/ORT curriculum developed and utilized by the Kwara State Trainers. E) Reviewed MOH quarterly statistics for client attendance and acceptance of family planning methods at all MOH facilities. F) Received verbal agreement from the Permanent Secretary and Director of Health Services for the participation -2­ of two members of the Kwara State Training Team as co­ trainers in the Lagos State MOH/INTRAH FP/ORT/CHE training project. III. BACKGROUND This was the eighth INTRAH visit to Kwara State. A needs assessment and project development visit was conducted in November 1984 (Trip Report #0-06); a sub contract was developed with the Ministry of Health in January 1985 (Trip Report #0-18) A series of 5 training activities designed to develop institutional capabilities of the MOH to provide family pl&nning in-service training was completed in May 1986. These activities were as follows: TRIP WORKSHOP REPORT NO. 1) TOT Workshop and Health Education 0-124 2) FP/ORT Curriculum Development 0-119 3) FP/ORT Service Delivery Skills 0-120 4) Management/Supervision/Evaluation 0-121 5) Project Review & Follow-Up 0-78 This visit provided the initial opportunity for an INTRAH representative to observe Kwara State Trainers conduct in-service training. IV. DESCRIPTION OF ACTIVITIES Activities during the two day visit focused on the following: Meetings with MOH officials to discuss the present status and future plans of the child spacing program in Kwara State and related training needs. The capability of the MOH to sustain in-service training given financial constraints as funds under MOH-INTRAH subcontract are nearly depleted. Visits to FP clinical facilities used for in­ service trainee clinical practica. -3- Observation of members of the training team during the 5th FP/ORT workshop. V. FINDINGS AND CONCLUSIONS A. Child-BSacing Program 1. Finding The MOH operates 70 health care facilities throughout the state which offer MCH services. Fifty-three facilities offer FP service and are staffed with 1 or 2 trained service providers. It is anticipated that by the end of 1988 all 70 facilities will offer a range of FP services and each will be staffed by 2 trained clinicians. Local Government Areas (LGA) operate 265 facilities which include maternities and dispensaries. LGA officials plan to offer a range of family planning services in 90 facilities by the end of 1988. In preparation, LGA officials have requested the MOH to allocate slots for LGA personnel in every FP/ORT service delivery skills workshop. The MOH has agreed to accept 3-4 participants per workshop. Conclusion The strategy to implement child-spacing services throughout Kwara State, particularly in MOH facilities, has been carefully planned by the Director of Health Services and the FP Coordinator. There is an apparent need to continue in-service training for MOH and LGA personnel in order to meet the established goals. 2. Finding Supervision of FP services and personnel is the responsibility of the State FP Coordinator and the Deputy Coordinator. Logistical constraints and lack of financial support hinder supervisory activities. The MOH has expressed a need to conduct a Supervision and Management workshop to prepare at least 12 zonal supervisors who already have had FP training. Conclusion The MOH recognizes the importance of supervision of FP services and personnel in order to improve and maintain quality of CS services. -4- B. Service Statistics 3 . rn4ing a. A review of MOH/FP service statistics for the period July - September 1986 revealed: a well designed and detailed system of data collection (refer to report in Appendix B). - 6 of the 54 MOH facilities which offer CS services reported an average of 6-15 client visits daily. The 48 remaining clinics average 1.4 client visits daily. b. It was learned that the Pathfinder Fund will sponsor a male attitude survey to determine reasons for under-utilization of existing child-spacing services in the Ilorin area.
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