| Description |
Nigeria is a Federal Republic where power is distributed among the executive, legislative and judicial arms of the government. The country is divided into thirty-six states (36) and the Federal Capital Territory (FCT), which are further subdivided into seven hundred and seventy-four (774) Local Government Areas (LGAs). These LGAs are further structured into about ten thousand (10,000) political Wards. The states and the FCT are aggregated into six geo-political zones, namely: North-Central, North-East, North-West, South-East, South-South, and
South-West.
Nigeria is the most populous country in Africa with an estimated population of 223 million people. It has an annual birth rate of 37 per 1000, neonatal mortality rate of 39 per 1000 live birth, under 5 mortality rates of 132 per 1000 live birth, maternal mortality
ratio of 512 per 100,000, live-birth and death rate of 13 per 1000, a growth of 2.4% per annum and a population density of 234 people per sq.km. The country’s population is diverse with more than 300 ethnic groups and well over 500 languages/dialects spoken. It has a Nominal Gross Domestic Product (GDP) of N229,912,937,295,758.00, Real GDP of N76,684,940,769,791.00 and real growth rate of 2.74% in 2023. These contextual factors make it increasingly challenging to meet the health demands of the populace and perhaps even more challenging to improve the quality of services. |
| Table of contents |
Table of Content
Table of Content ..................................................................................................................... ii
List of Figures....................................................................................................................... viii
List of Acronyms ................................................................................................................... xvi
Foreword .............................................................................................................................. xix
Acknowledgement ................................................................................................................ xx
Executive Summary .............................................................................................................. xxi
Introduction ............................................................................................................................ 1
1.1 Background ....................................................................................................................... 1
1.2 Country Context ................................................................................................................. 2
1.3 Health Sectoral and Institutional Context ............................................................................ 4
1.4 Survey Justification ............................................................................................................ 6
1.5 Survey Objectives ............................................................................................................... 7
1.6 Coverage ........................................................................................................................... 7
2.1 Health Facility Mapping /Listing Exercise .................................................................................... 9
2.2 Sampling Method ...................................................................................................................... 9
2.3 Pre-Test of Questionnaires ................................................................................................ 11
2.4 Finalisation of Survey Questionnaires and Field Manual ............................................................ 11
2.5 Personnel Recruitment and Selection ...................................................................................... 11
2.6 Trainings ................................................................................................................................ 12
2.6.1 Training of Trainers (ToT) ........................................................................................................................... 12
2.7 Field Data Collection .............................................................................................................. 13
2.8 Quality Assurance (QA)............................................................................................................ 14
2.8.1 Coordination and Monitoring ..................................................................................................................... 14
2.9 Data Management ................................................................................................................... 14
Findings ................................................................................................................................ 16
3.1.1 Clinical Competence of Health Workers .................................................................................................... 16
3.1.2 Accurate Diagnosis of Clinical Conditions .................................................................................................. 18
3.1.3 Accurate Diagnosis Made by Different Cadres of Health Workers ................................................................ 20
3.1.4 Adherence to Guidelines ........................................................................................................................... 22
3.1.5 Management of Maternal and Neonatal Complications (MMNC) ................................................................. 24
3.2 Provider Knowledge of Integrated Management of Childhood Illnesses (IMCI) Protocol for
Diagnosis and Treatment of the Sick Child ..................................................................................... 30
3.2.1 Knowledge of Assessment and Treatment of IMCI Core Disease Entities ................................................ 30
3.2.2 Health Workers (Trained and Untrained) with Adequate Knowledge of IMCI Key Danger Signs and Main
Symptoms ........................................................................................................................................................ 31
3.2.3 Health Workers in PHFs with IMCI Training who have Knowledge of Assessment and Treatment of Core IMCI
Disease Entities ................................................................................................................................................ 33
3.3 Essential Drugs and Basic Equipment ...................................................................................... 35
3.3.1 Availability of Essential Drugs .................................................................................................................... 35
3.3.2 Availability of Basic Medical Equipment ................................................................................................ 37
3.4 RMNCAH+N Service Delivery ................................................................................................... 38
3.4.1 Family Planning Services ........................................................................................................................... 38
3.4.2 Health Facilities who Provide Family Planning Counselling Service During ANC............................................ 38
3.4.3 Availability of Family Planning Commodities in Health Facilities .................................................................. 39
3.4.4 Health Facilities that Provides Antenatal Care Services .............................................................................. 41
3.4.5 Routine ANC Drug Administration .............................................................................................................. 42
Iron Supplement........................................................................................................................................... 42
Folic Acid ..................................................................................................................................................... 43
Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) .................................................................... 44
Routine Monitoring of Blood Pressure ............................................................................................................ 45
Tetanus Toxoid Immunization as Part of ANC Services .................................................................................... 45
3.4.6 Corticosteroid .......................................................................................................................................... 46
3.4.7 HIV Testing Services.................................................................................................................................. 47
3.4.8 Anti-Retroviral (ARV) Services .................................................................................................................. 47
3.4.9 Sexually Transmitted Infections (STIs) Diagnostic and Treatment Services ................................................... 48
3.4.10 Early Infant Diagnosis (EID) On-Site ......................................................................................................... 49
3.4.11 Prevention of Mother to Child Transmission (PMTCT) Services ................................................................... 50
3.4.12 Provider Knowledge of Protocol for PMTCT during ANC ............................................................................. 50
3.4.13 Breakdown of Provider’s Knowledge of PMTCT into its Components ........................................................ 51
3.4.14 Health Providers’ Knowledge for HIV Testing at the Booking of ANC Visit .................................................... 51
3.4.15 Knowledge of Health Providers on PMTCT Service on who should be Tested .............................................. 51
3.5 Documentation of Care Process for ANC, Suspect Malaria in Under-5 and PMTCT Services ... 53
3.5.1 Documentation of Antenatal Care (ANC) .................................................................................................... 53
Documentation of Screening for STI/HIV/AIDS during ANC .............................................................................. 53
Documentation of Blood Pressure ................................................................................................................. 54
Documentation of Anaemia .......................................................................................................................... 54
Documentation of Interventions for the Prevention of Malaria in Pregnancy ..................................................... 54
3.5.2 Documentation of Care Process for Malaria .......................................................................................... 55
3.5.3 Documentation of PMTCT Services for HIV Positive Mother-Infant Pair ................................................... 56
3.5.4 Delivery Services ...................................................................................................................................... 56
3.5.5 Skilled Birth Attendants including Community Health Extension Workers (CHEWs) ...................................... 57
Excluding CHEWs ......................................................................................................................................... 58
3.5.6 Oxytocin .................................................................................................................................................. 59
3.5.7 Magnesium Sulphate (MgSO4) ................................................................................................................... 59
3.5.8 Bag and Mask for Infant Resuscitation ....................................................................................................... 60
3.5.9 Basic Delivery Equipment.......................................................................................................................... 60
3.5.10 Foetal Stethoscope ................................................................................................................................. 61
3.5.11 Partograph ............................................................................................................................................. 61
3.5.12 Sterile Cord Clamps ................................................................................................................................ 62
3.5.13 Sterile Scissors ....................................................................................................................................... 62
3.5.14 Episiotomy Scissors ................................................................................................................................ 63
3.5.15 Postnatal Care Services .......................................................................................................................... 64
3.5.16 Postnatal Care Guidelines ....................................................................................................................... 65
3.5.17 Postnatal Care Job-Aids ......................................................................................................................... 66
3.6 Child Health Services .............................................................................................................. 67
3.6.1 Child Growth Monitoring Services ............................................................................................................ 67
3.6.2 Provision of Immunisation Services ........................................................................................................... 67
3.6.3 Measles and Yellow Fever Vaccines ......................................................................................................... 68
3.6.4 Malnutrition Treatment ............................................................................................................................ 68
3.6.5 Vitamin A ................................................................................................................................................. 68
3.6.6 Pneumonia Treatment .............................................................................................................................. 69
3.6.7 Treatment for Watery Diarrhoea................................................................................................................. 69
3.6.8 ORS in the Treatment of Watery Diarrhoea ................................................................................................. 70
3.6.9 Zinc Supplement in the Treatment of Watery Diarrhoea............................................................................... 70
3.6.10 Integrated Management of Childhood Illnesses (IMCI) Guidelines ............................................................. 71
3.6.11 Job-Aids for Child Services ...................................................................................................................... 72
3.7 Maternal, Newborn and Child Health Week and Vitamin A Distribution Services ......................... 73
3.7.1 Maternal, Newborn, and Child Health (MNCH) Week ................................................................................. 73
3.7.2 Guidelines for Newborn Sepsis .................................................................................................................. 74
3.7.3 Adolescent Health Services....................................................................................................................... 74
3.7.4 Special Location for Providing Adolescent Health Services ......................................................................... 74
3.8 Clinical Competence of Health Workers ................................................................................... 76
3.8.1 Knowledge of Who Should be Tested (ANC Women) ................................................................................... 77
3.8.2 Knowledge of Who Should be Tested (Partner of ANC Woman) .................................................................... 77
3.8.3 Knowledge on Care of Newborn of HIV Positive Pregnant Women (Newborn Stops Nevirapine at Six Weeks).. 78
3.8.4 Knowledge on Care of HIV-Positive Pregnant Women (Pregnant Woman should be tested at First ANC) ........ 78
3.8.5 Knowledge on Care of Newborn of HIV-Positive Pregnant Women (Newborn Starts Cotrim until HIV status is
known) ............................................................................................................................................................. 79
3.8.6 Knowledge on Care of HIV-Positive Pregnant Women (Pregnant Woman should be re-tested after 3 Months) . 79
3.8.7 Knowledge on Care of HIV Positive Pregnant Women (Mother starts ARV when HIV+ status is known) ........... 80
3.8.8 Knowledge on Care of HIV-Positive Pregnant Women (Mother remains on ART for Life) ................................. 80
3.8.9 Care of Newborns of HIV-positive women (Newborn re-tested again at 6 weeks, 6 months and 18 Months) ... 81
3.9 Malaria ................................................................................................................................... 82
3.9.1 Long-Lasting Insecticide-Treated Net (LLIN) or LLIN Voucher Distribution .................................................... 82
3.10 Tuberculosis (TB) Service Availability...................................................................................... 84
3.10.1 TB Guidelines for Adult ............................................................................................................................ 84
3.10.2 TB Guidelines for Children ....................................................................................................................... 85
3.10.3 TB Infection Control ................................................................................................................................ 85
3.10.4 Laboratory Staff Trained for TB ................................................................................................................. 85
3.10.5 Availability of TB Microscopy ................................................................................................................... 86
3.10.6 Availability of First-Line TB Drugs ............................................................................................................. 86
3.10.7 Infection Control..................................................................................................................................... 87
3.10.8 Safely Disposal of Sharp Waste ............................................................................................................... 87
3.10.9 Safe Disposal of Medical Waste ............................................................................................................... 87
3.10.10 Visible Sharp and Medical Wastes in Service Areas Prior to Removal Off-Site ........................................... 88
3.11 Management .................................................................................................................... 89
3.11.1 Financial Management .................................................................................................................... 89
3.11.2 Health Care Financing .................................................................................................................... 92
3.11.3 Integrated Supportive Supervision (ISS) ............................................................................................ 93
3.11.3a Percentage of PHFs that Reported at least one ISS Visit in the 3 Months Preceding the Survey ................... 93
3.11.3b Percentage of PHFs that Reported Use of Check-List During the Most Recent ISS Visit .............................. 95
3.11.3c Percentage of PHFs with Observed Copies of ISS Check-List Left with the Facility .................................... 96
3.11.3d Percentage of PHFs whose ISS Documentation Contains Recommendations on QoC or Facility Supervision
........................................................................................................................................................................ 96
3.11.3e Percentage of PHFs whose ISS Documentation contains Recommendations on Facility Management ....... 97
3.11.4 Health Management Information System (HMIS)....................................................................................... 97
Percentage of Primary Health Facilities that Accurately Reported HMIS Data for the Three Months Preceding the
Survey .............................................................................................................................................................. 97
Percentage of Under reporting of HMIS Services ............................................................................................... 101
Percentage of Primary Health Facilities with Availability of Source Documents for Key Service Areas ................... 103
3.12 Non-Communicable Diseases .......................................................................................... 106
3.12.1 Diabetes Services, Guidelines and Staff Trained ............................................................................. 106
3.12.2 Hypertension Services, Guidelines, and Trained Staff ............................................................................. 110
3.13 Non-Communicable Disease Equipment ............................................................................... 113
3.13.1 Peak Expiratory Flow Meters .................................................................................................................. 113
3.13.2 Functional Spacers Device .................................................................................................................... 113
3.13.3 Blood Pressure (BP) Monitors (Digital & Calibrated Manual Devices) ........................................................ 114
Discussion .......................................................................................................................... 118
4.1.1 Diagnostic Accuracy ............................................................................................................................... 118
4.1.2 Adherence to Guidelines.................................................................................................................... 119
Management of Maternal and Neonatal Complications ..................................................................................... 119
4.2 Provider Knowledge of Protocol for Diagnosis and Treatment of Sick Child ................................ 120
4.2.1 Management of Childhood Illnesses ................................................................................................... 120
4.3 Availability of Drugs and Equipment ........................................................................................ 122
4.3.1 Availability of Essential Drugs .................................................................................................................. 122
4.4 Readiness of Health Facilities to deliver Key Interventions, STIs and TB Services ....................... 123
4.4.1 PMTCT Services ................................................................................................................................. 123
4.4.2 Family Planning Services ......................................................................................................................... 124
4.4.3 Maternal, New-Born, and Child Health Week (in the past 6 months) and Vitamin A Distribution (in the last
MNCH Week) .................................................................................................................................................. 124
4.4.4 Prevention from Mother-to-Child Transmission (PMTCT) Services .............................................................. 125
4.4.5 Antenatal Care Services .......................................................................................................................... 125
4.4.6 Delivery Services .................................................................................................................................... 126
Postnatal Services .......................................................................................................................................... 126
4.4.7 Child and Adolescent Health ................................................................................................................... 127
4.4.8 Clinical Competence of Health Workers .................................................................................................. 128
4.4.9 Sexually Transmitted Infections (STIs) ...................................................................................................... 128
4.4.10 Malaria ................................................................................................................................................. 129
4.4.11 Tuberculosis Service Availability and Readiness ..................................................................................... 129
4.4.12 Availability of Skilled Birth Attendants (SBAs) .......................................................................................... 130
4.4.13 Infection Control................................................................................................................................... 131
4.4.14 Provision of Immunisation Services ....................................................................................................... 131
4.5 Management ................................................................................................................... 133
4.5.1 Financial Management ...................................................................................................................... 133
4.5.2 Healthcare Financing ........................................................................................................................ 133
4.5.3 Integrated Supportive Supervision ...................................................................................................... 133
4.5.4 Health Management Information System (HMIS) ................................................................................. 134
4.6 Non-Communicable Diseases (NCDs) ..................................................................................... 135
4.6.1 Diabetes ................................................................................................................................................ 135
4.6.2 Hypertension .......................................................................................................................................... 135
4.6.3 Equipment ............................................................................................................................................. 136
Challenges of the Survey and Lessons Learnt ....................................................................... 137
5.1. Challenges ........................................................................................................................... 137
5.1.1 Data Collection Challenges ..................................................................................................................... 137
5.2 Steps Taken to Overcome the Challenges ......................................................................... 137
5.3 Lesson Learnt ................................................................................................................. 138
References ......................................................................................................................... 139
Annex ................................................................................................................................. 142
Appendix I .................................................................................................................................. 144
Appendix II ................................................................................................................................. 151
Appendix III ................................................................................................................................ 180
Appendix IV ................................................................................................................................ 253
Appendix V ................................................................................................................................. 266 |
