Getting It Together In 72 Hours: CCP-NURHI Clinic Remodelling Experience KADUNA STATE CENTRE OF LEARNING THE 72-HOUR CLINIC MAKEOVER COMPENDIUM KADUNA STATE ii Acronyms Acronyms ANC Antenatal Care CHC Comprehensive Healthcare Centre CLMS Contraceptive Logistics Management System CPR Contraceptive Prevalence Rate DVD Digital Versatile Disc FCT Federal Capital Territory FP Family Planning GH General Hospital HC Honourable Chairman HCH Honourable Commissioner for Health IUD Intra Uterine Device KM Kilometre LASU Lagos State University LCDA Local Council Development Area LGIC Local Government Interim Chairman LGA Local Government Area mCPR Modern Contraceptive Prevalence Rate MDF Medium Density Fibre NDHS Nigeria Demographic and Health Survey NURHI Nigerian Urban Reproductive Health Initiative OIC Ofcer-In-Charge PHC Primary Healthcare Centre PIA Performance Improvement Assessment PIP Performance Improvement Plan RH Reproductive Health SA Sole Administrator SQM Square Meter WDC Ward Development Committee iii iv Acknowledgements In its determination towards ensuring improved maternal, newborn and child health in Nigeria, the gements Nigerian Urban Reproductive Health Initiative (NURHI 2) project narrates one of its proven Acknowled interventions - 72-Hour Clinic Makeover concept and process. The NURHI 2 project is built on the premise that demand for family planning is a requirement for increased contraceptive use, therefore it is important to generate demand and ensure that supply meets the demand by improving access to quality FP services. This compendium narrates a stepwise guide on how the 72-Hour Clinic Makeover concept is being implemented in the project supported states; Kaduna, Lagos and Oyo. It also contains information on the facilities that benetted from the 72-Hour Clinic Makeover in these states. NURHI 2 would like to appreciate the immense contributions of the Federal Ministry of Health, State Ministries of Health (Kaduna, Lagos and Oyo), National Primary Health Care Development Agency, State Primary Health Care Development Agencies in Kaduna, Lagos and Oyo, and the Local Council Development Agency in Lagos State. Our sincere gratitude also goes to the Ward Development Committees and community members for their involvement and commitment in the process and each supported LGA for their donations and support all through the process in ensuring it becomes a reality. NURHI 2 would also like to acknowledge with much appreciation the efforts and hard work of our core partners; Association for Reproductive and Family Health (ARFH) and Centre for Communication Programs Nigeria (CCPN), in providing the necessary support for quality improvement and community mobilization respectively. It also appreciates the efforts of the entire staff members of Johns Hopkins Center for Communication Programs (CCP), the prime organization of the NURHI project, for their commitment in making the 72-Hour Clinic Makeover process a success. It is our expectation that all tiers of government, other stakeholders and good- meaning Nigerians will take this document and move it beyond a compendium into action and reality that will be replicated at all levels so as to improve the health of everyone especially women and children in Nigeria. Dr. Saratu Olabode-Ojo Senior Technical Advisor – Service Delivery and Health Systems Strengthening. CCP-NURHI 2 v vi Foreword NURHI 2 envisions a Nigeria where supply and demand barriers to contraceptive use are eliminated and a positive shift in family planning social norms at the structural, service, and community levels that drive increases in Contraceptive Prevalence Rate (CPR) in Kaduna, Lagos, and Oyo states. Family Planning/Child Birth Spacing has been proven to be one of the key factors to reduction in maternal and child mortality, making it a very vital intervention for improving the quality of life of women and children. With NURHI's proven interventions in the family planning landscape, there is a Foreword move by key stakeholders to successfully redirect and improve the health and economic indices of the country, through high impact MNCH interventions. One of NURHI's proven intervention to address supply barriers at these three targeted levels to improve the quality of family planning services and expand access of these services to more men and women is the 72-Hour Clinic Makeover concept. The concept ensures that all NURHI 2 supported facilities have basic equipment and infrastructure using a cost-effective way. The methodology is to use direct labour through community-based artisans who are hired to provide services to give the facility a 'face lift' thereby providing a private and safe environment for condential counselling and family planning method administration. The overall aim is to provide quality family planning services and access to care in line with the National Family Planning Service Protocol. This compendium contains the list, pictures and details of facilities that have benetted from the 72- Hour Clinic Makeover with the list of equipment and infrastructure. It also details the challenges and success stories recorded in implementing the process. Our desire is that this innovation, if replicated appropriately would cause a positive shift in providing an integrated, comprehensive, and holistic approach to improve the Nigerian health system at all levels of care. Dr. Mojisola Odeku, Portfolio Director, CCP Nigeria FP Portfolio vii Copyright 2018 ISBN: 978-978-964-829-0 viii Table of Contents Acronyms Acknowledgements Foreword Introduction IGABI LOCAL GOVERNMENT AREA Table of Table Contents Comprehensive Healthcare Clinic (CHC) Jaji-Igabi Rigasa General Hospital Kwarau Tasha Primary Healthcare Centre Kampani Zango Primary Healthcare Centre Mando Primary Healthcare Centre JEMA’A LOCAL GOVERNMENT AREA Kafanchan Primary Healthcare Centre General Hospital Kafanchan ZANGON KATAF LOCAL GOVERNMENT AREA General Hospital Zangon Kataf KACHIA LOCAL GOVERNMENT AREA General Hospital Kachia KAURU LOCAL GOVERNMENT AREA General Hospital Kauru Kwassam Primary Healthcare Centre KUBAU LOCAL GOVERNMENT AREA General Hospital Pambegua Dutsen-Wai Primary Healthcare Centre Kubau Primary Healthcare Centre Pambegua Primary Healthcare Centre ix LERE LOCAL GOVERNMENT AREA General Hospital Saminaka Garun Kurama Primary Healthcare Centre SOBA LOCAL GOVERNMENT AREA Richifa Primary Healthcare Centre Soba Primary Healthcare Centre Yakassai Primary Healthcare Centre AVERAGE COST FOR EQUIPPING THE FP UNIT AND LABOUR WARD x INTRODUCTION The Nigerian Urban Reproductive Health Initiative (NURHI) is funded by the Bill & Melinda Gates Foundation with the vision to eliminate supply and demand barriers to contraceptive use and make family planning (FP) a social norm in Nigeria. In phase one (2009 – 2014), NURHI signicantly contributed to the increase in family planning contraceptive prevalence rate (CPR) in four initial cities; FCT, Ibadan, Ilorin and Kaduna and scaled up to Benin and Zaria. These cities were selected because they each have an average population of over one million.Currently, NURHI is in its second phase, and is operating across three states namely Kaduna, Lagos and Oyo. Kaduna State, located in the North Western geopolitical zone in Nigeria has a population of 6.11 million and an annual population growth rate of 2.47 percent. The population of the state is young and growing, with 44 percent of the population under the age of 15, and about 5 percent of the population (1.44 million) are women in the reproductive age group (14 to 49 years) (NDHS, 2013). This means that the state is burdened with the challenge of providing for a growing population during a period of limited resources, while also ensuring that its citizenry enjoy quality health, education, employment, etc. Family planning has been identied as a key intervention that not only contributes to reducing maternal, infant, and child mortality, but can also ensure states attain their demographic dividends. Introduction This means that in addition to reducing unintended pregnancies and ensuring healthy spacing between births, families that use contraception are likely to have healthier families. Also, young people are provided with the opportunity to stay in school longer, have a clear life purpose and be able to achieve their dreams. NURHI 2 is committed to contributing towards achieving the State's goal of increasing its CPR to 46.5 percent by 2020. The project uses a three-prong approach of Advocacy, Demand Generation and Service Delivery to increase local support for contraceptive use, while expanding demand and access to high quality and affordable family planning services. 72-Hour Clinic Makeover Process The 72-hour clinic makeover activity is implemented from start to nish in close collaboration with the health regulatory agencies in the state with the aim of having a waiting area, counselling room and procedure room which is based on space available in each facility.The implementation takes place within 72 hours. It starts after close of work on Friday and is completed before resumption of work the following Monday. At the beginning of the project, NURHI 2 selected the intervention sites and conducted a Performance Improvement Assessment (PIA) of these health facilities with the aim of understanding the current state of family planning service delivery and also identifying gaps in training, equipment, infrastructure, logistics, data documentation and reporting. The ndings from the PIA were used to develop the Performance Improvement Plan (PIP),