f' D - (\ .':\ f:) .' I I '-\ ,," ~') ( ff DEP ..l.RT\lE:'H OF HEALTH & l-JU.\IAN SERVICES Public Health SerlJice Centers for Disease Control " \',,"­ . -....~.., "" ,-'­ l'vlemorandum July 21, 1983 ~lichael From E. Dalmat, Dr.P.H., Public Health Advisor, Program Evaluation Branch, Division of Reproductive Health (ORH), Center for Health Promotion and Education (CEPE) Foreign Trip Report (AID/RSSA): Nigeria, June 4-19, 1983 Tu ltJ'illiam H. Foege, H.D. Director, Centers for Disease Control Through: Dennis D. Tolsma Acting Director, CHPE nO~ SUMMARY I. PLACES, DATES, AND PURPOSE OF TRAVEL II. PRINCIPAL CONTACTS III. PROGRAM DEVELOPHENT ACCOMPLISHHENTS A. Oyo State Community-Based Distribution Project B. Ogun State Family Planning Proposal C. Nigerian Army Family Planning Proposal D. Lagos CBD/cRS Project IV. CONTRIBUTIONS TO THE AID POPULATION ST~~TEGY A. Contraceptive Distribution System B. Projections of Commodity Requirements TABLES 1-12 FIGURES 1-2 SUMMARY Technical assistance from the Division of Reproductive Health (DRR) was requested by the Pathfinder Fund and the AID representatives to Nigeria. Pathfinder asked for assistance (1) in reviewing the progress of the Dyo State community-based distribution (CBD) project that it suppor.ts and in formulating recommendations for the expansion of the project, and (2) in assisting Ogun State ~tlnistry of Health staff in developing the technical aspects of its proposal to incorporate family planning services into the operations of its primary health care clinics. The AID representative asked for DRR input into the (1) design of a contraceptive distribution system to support existing and future family planning programs in Nigeria, and (2) projection of contraceptive requirements for Nigeria during the next 5 years. Dr. Dalmat completed both tasks requested by the Pathfinder Fund. In addition, the CDC consultant identified the potential areas of technical assistance that DRR could offer to Pathfinder-supported programs in Nigeria: (1) developing commodity supply systems including requisitions, distribution, and inventory control; (2) designing and testing service statistics systeQs; (3) defining the roles, responsibilities, and techniques to be used by tech­ nical supervisors; and (4) analyzing and, when necessary, modifying staffing patterns, appoint:nent systems) the utilization of space and cornnodity storage facilities and procedures. \ Page 2 - W:llliam H. Focg e, ~-1. D. DRH representatives will participate in a meeting with the AID representative from Nigeria, a representative of the Federal Ministry of Health of Nigeria, and representatives from several AID intermediary organizations from August 3-4, 1983, in Washington. During this meeting, the role that each organiza­ tion will play in support of new family planning programs in Nigeria will be clarified. I. PLACES, DATES, AND PURPOSE Of TRAVEL During the consultation (June 4-19, 1983), Dr. Dalmat assisted (1) the Pathfinder Fund in reviewing existing programs and developing new family planning project strategies with potential Nigerian grantees, and (2) AID in developing a strategy for the support of family planning population programs in Nigeri~. Assistance was provided in Lagos, Ibadan (Oyo State), and Abeokuta (Ogun State). This travel was in accordance with the Resource Support Services Agreement (RSSA) between CDC/CHPE/DRH and AID/S&T/POP/FPS. II. PRINCIPAL CONTACTS u.s. Embassy 1. Mr. John Norris, Acting Deputy Ambassador 2. Hs. I(eys NacHanus, AID representative The Pathfinder Fund 1. Dr. Dierdre Strachan, Chief, Fertility Services 2. Dr. Ayorinde (Ayo) Ajayi, Senior Program Officer, Africa AID Consultants (American Public Health Association) 1. Dr. Elizabeth Connell, Department of Gynecola5Y and Obstetrics, Emory University School of Nedicine 2. Ms. Peggy Curlin, Center for Development and Population Activities (CEDPA) 3. Dr. Harald Pedersen, Private Consultant 4. Dr. Rocco Piotrow, Population Communications Services, Johns Hopkins University 5. Mr. Stephen Smith, Regional Program Coordinator, Population Communications Services, Johns Hopkins University 6. Dr. rmy Yacoob, African Studies and Research Center, Howard University Federal ~linistry of Health Dr. A. B. Sulaiman, Director, National Health Planning and Research 2. Dr. O. A. Adelaja, Senior Consultant, Medical Statistics 1. Dr. J. A. Laole, Assistant Director, Health Education 4. Dr. P. Y. Odunsi, Senior Consultant, Epidemiology 5. Dr. A. O. Okunsanya, Senior Consultant, National Health Planning 6. Mrs. A. O. Payne, Deputy Chief Nursing Advisor Oyo State 1. Dr. P. A. Ibeziako, Acting Head, Department of Obstetrics and Gynecology, University Hospital (UCH), Ibadan 2. Mrs. Grace Ebun Delano, Chief Coordinator, Fertility Research Unit/Clinical Training Program; Assistant Director, Community­ Based Distribution (CBD) Program, UCH, Ibadan Page 3 - William H. Foege, M.D. 3. Mrs. Alice Adekola, Project Administrator, CBD Program UCH, Ibadan 4. Hr. M. A. Adesiyun, Permanent Secretary, State Ministry of Health, Ibadan 5. Dr. Dejo Raimi, Chief Medical Officer, State Ministry of Health, Ibadan 6. Dr. Olapoju Taiwo, Secretary, State Health Council, Ibadan • 7. 11rs. o. o. Williams, Chief Nursing Sister, State Health Council, Coordinator, CBD Program, Ibadan 8. Mrs. E. F. O'Wwyer, CBD Program Officer, State Health Council "s. F. o. Fakunle, Chief Area Coordinator, Akinyele North, CBD Program .oniya 3. S. O. Areola, Nurse Hidwife-in-Charge, Ikereku Maternity, eBD Project Supervisor, Ikereku 11. Miss B. K. Oyelakin, Community Health Assistant, Ikereku ~~ternity, Assistant CnD Project Supervisor, Ikereku 12. Mrs. A. Oledere, Senior Ward l~id, Ikereku ~~ternity, Assistant CBD Supervisor, Ikereku 13. Mr. Timothy .Akinwale, Village Health Assistant, CBD Program, Ikereku Ogun State 1. Mr. Odulano, Permanent Secretary, State ~tlnistry of Health, Abeokuta 2. Dr. S. A. Onadeko, Acting Secretary, Chief Medical Officer, State Health I'~nagement Board, Abeokuta 3. Hrs. V. E. Babalola, Chief, ~~trone for Hospitals, State Health ~~nagement Board, Abeokuta 4. Mrs. F. A. Olata, Chief Health Sister (Primary Health Care), State Health ~~nagement Board, Abeokuta 5. Hrs. I. V. Mako, Assistant Chief Health Sister, State Health Hanagement Board, Abeokuta 6. Dr. S. Ayodele Oni, Medical Officer of Health (Northern Zone), Abeokuta Others 1. Professor Ransum-Kuti, Director, Institute of Child Health, University of Lagos, Lagos Dr. (Hrs.) Adepeju Olukoya, Institute of Child Health, Senior Consultant, Shomolu Comlnunity Health Project, Shomolu (Lagos) 3. Mrs. Babalola, Educationalist, Shomolu Clinic, Shomolu (Lagos) 4. Hrs. Gladys Olabisi, Family Health Assistant, Shomolu Community Health Project, Shomolu (Lagos) ~~jor General J. U. Ekong, Medical Director, Nigerian Army, Bonny Camp, Lagos 6. Colonel S. A. Majekodunmi, Chief of Medical Planning, Nigerian Army, Bonny Camp, Lagos 7. Colonel Simkaiyc, Batallion Hedical Director, Enduyo III. PROGRAJ1 DEVELOp~mNT ACCOMPLISH}lliNTS A. Oyo State Community-Based Distribution (CBD) Project In 1979, Columbia University began p~oviding financial and technical assist­ ance to the University College Hospital (UCH), Department of Obstetrics and Page 4 - HilHam H. Foege, H.D. Gynecology, for the purposes of: (1) establishing a demonstration CBD program that would offer family planning, basic antenatal and childbirth services, as well as treatment or referral of common morbidity; and (2) conducting opera­ tions research to test alternative approaches to delivering these s~rvices. (1) Catchment Area: During the demonstration phase of the project, service delivery has been established in one zone, Akinyele. In this zone, 164 village service pro­ viders (61 percent are female and are trained traditional birth attendants TBA's)), and 39 percent are male and are voluntary health workers (VHVl's) provide services to a catchment area population of 85,000 (see Table 1). Overall, village workers serve communities with 518 inhabitants. (2) Supervision: Supervision is provided by three tiers of health workers: Site of Supervisory Supervisors Personnel No. Cadre UCH, Ibadan 2-4 Senior Nurse-~tldwives Akinyele Zonal 1 Ex:erienced Registered Headquarters, Moniya Midwife Each Area with the 1 Nurse-Midwife and/or Zone (from ~~ternity 1 Community Health or Health Center) Assistant (CRA) and/or 1 '..lard Maiden Reportedly, each village service provider is supervised in the village once every 4-6 weeks. During these visits, the supervisor (nurse-midwife, ca~, or wardmaid) visits three-to seven families with the TBA or Vill~. Further, the supervisor (1) inspects TBA/VHW kits, (2) assists in solving problems that arise, (3) inspects the TBA's/Vln~'s home to make sure that it can serve as a community model, and (4) reviews the TBA's/VHW's supplies and tally shp.ets (record of services provided a~d referrals made). In addition to being supervised in the village, all TBA's and vm~'s attend two meetings each month. During the first meeting with the area supervisor(s), the TBA's/~fH's (1) receive new supplies (contraceptives, dr~gs, recordkeeping forms), (2) discuss problems related to their I.,ork, including the use of the tally sheets, and (3) review hOloT a.nd when to administer drugs and I"hen and where to refer complicated patients. The zonal supervisor, Mrs. Fakunle, and UCH supervisors attend the second monthly meeting. T!-ese meetings are used (1) to identify and help solve problems encountered by TBA's/VHW's in their work and (2) to provide continuing education to the TBA's/VH\~'s.