Transforming Women and Child health care program in Cross River State

Cross River State Community Health Department Primary Health Care Program managed by Tulsi Chanrai Foundation

To sustain and be effective in delivering Primary Health Care services to the people in Cross River State, especially among rural dwellers and hard-to-reach communities, Cross River State (CRS) initiated a partnership with Tulsi Chanrai Foundation (TCF) in 2009 to improve the status of Primary Health Care program in the State.

The baseline survey conducted in 2010 indicated that the Infant Mortality Rate was 75/1000. Under 5 years – Mortality was 157/1000, Maternal Mortality rate was 545/1000, Ante-natal Coverage was only 55 per cent, Skill birth attendance by health workers was 39 per cent and only 74% of one year old children were fully immunized.

Goals of partnership with Tulsi Chanrai Foundation and Cross River State are to achieve the following:

a.       Infant Mortality Rate -  30 / 1000 Live Births

b.      Under-5 Mortality Rate – 75 / 1000 Live Births

c.       Maternal Mortality Rate – 250 / 100000 Live Births

d.      Antenatal Coverage – One visit: 95%; Four visits: 85%

e.       Skilled birth attendance by health workers – 85%

f.       One year child fully immunized – 90%

Targeted population and reach:

The beneficiaries of the program are population dwelling in the remote areas of CRS. The CRS is divided into 18 Local Government Areas (LGAs). The program will cover all 18 LGAs in a phased manner. 2 LGAs covered in 2010, 6 LGAs in 2011, another 6 LGAs were covered in 2012 and 4 LGAs in the final phase will be covered in 2013.

The scope of work in CRS includes:

1. Establishment of health facilities for every 300-500 families with community   participation.
2. Training of health workers in basic midwifery skills.
3. Establishment of a viable health management information system. 
4. Provision of drugs with a functional Drug Revolving Fund mechanism. 
5. Monitoring, supervision of the health facilities
6. Ensuring community participation to create ownership at the grassroots.

Work in progress:

• TCF so far has covered 14 LGAs namely Abi, Akpabuyo, Bekwarra, Biase, Ikom, Obubra, Obudu, Odukpani, Obanliku, Yala, Boki, Etung, Yakurr, Bakassi.
• For supporting the implementation of the program and for monitoring and supervision TCF has appointed two Program Managers for South and North Senatorial Districts of the state in addition to Director-Primary Health Care and General Manager-Administration.
• In 14 LGAs, a total of 621 Health Facilities are operational and managed by TCF, benefiting 1027 communities with a population 2,460,820.
• Essential equipment and instruments have been supplied to all health facilities after taking existing inventory.
• A fresh baseline survey in 14 LGAs has been initiated to take stock of the health situation of the population.
• Under the project, 8 ambulances and 9 pickup vehicles have been made available by the Government to enable doctors to reach out to remote areas and to quickly transport serious patients to primary health centres or to the general hospital in Calabar.   

Community Health Worker on her Motorcycle 

• Health workers have also been provided 102 motorcycles for their outreach programs.
• Identified 94 Health facilities with erratic power supply are provided with    Generators.

Health Workers with a Generator

• In 14 LGAs, 13 local doctors have been appointed; one vacancy will be shortly filled.
• Drugs Stores with essential medicines have been refurbished in 8 LGAs. Seed drugs are supplied to 8 LGAs.
• Health Staff appointed by Local Government Service Commission :

        -   Community Health Extension Workers- 618

        -   Nurse Midwives – 167; Laboratory Technicians - 98

        -   Pharmacy Technicians-98

        -   Drivers -28 

CHEWs trained in Midwifery skills and Basic Eye Care 

•      980 CHEWs have been trained in Basic Midwifery Skills and Basic Eye Care.

Refurbished Drug Stores with drugs supplied by DRF Committee

• Central Drug Revolving Fund (DRF) Committees & LGA DRF Committees have been constituted to monitor the supply and consumption of essential drugs in health facilities.
• Task forces consisting of TCF representatives, LGAs representatives and Government officials have been constituted in 8 LGAs to monitor the effective functioning of health facilities. Joint review meetings are being conducted at regular intervals with community leaders to assess the impact on the ground.
• Monthly performance reports are collated from the health facilities, which are being reviewed by Task Forces, Community Leaders and TCF representatives and feedback is sent back to the health facilities. 

Impact: January 2013 – March 2013

While TCF has reached out to 14 LGAs till date, Health facilities in 8 LGAs (Abi, Akpabuyo, Bekwarra, Biase, Ikom, Obubra, Obudu & Odukpani) are fully operational. Health reporting is fully functional in these 8 LGAs from Jan 2013.

   

•      28,679 people have been provided primary healthcare service by trained community health workers and doctors. 
•      Community health workers have registered 5953 pregnant women (12 weeks above) and ante-natal care has been provided. 
•        A total of 3304 deliveries have been registered out of which 3123 have been performed by health workers.
•      2,789 infants weight was recorded at the time of the birth out of which 1,527 infants were between 2.5 – 3.0 KGs and 1,104 infants were above 3 KGs only 158 infants were below 2.5 KGs.
•     A total of 14,206 infants have been registered in health facilities out of which 6133 infants are fully immunized against BCG, DPT, Measles, Hepatitis, Yellow Fever and 7,421 have been partially immunized, their immunization will be completed in due course of time.
•       34,349 children under 5 years of age have been weighed at the health facilities, out of which 341 children were identified as malnourished. 303 children were put on supplementary feeding out of which 196 have been graduated to normal weight.
•              Pregnant women and under-5 children are given drugs free of cost by the Government under the free health scheme called Project HOPE and this program is coordinated by Tulsi Chanrai Foundation.
•               No. of pregnant women and children under 5 treated for some serious diseases:

Diseases	Under – 5 Children	Pregnant Women
Measles	264
Pneumonia	808
Diarrhoea	2,187
Malaria	9,483	2686
Severe Anaemia		36
Pre-eclampsia		2
HIV Positive		58
Total	12,742	2,782

  

Tulsi Chanrai Foundation is grateful to Cross River State and Four Acre Trust for their continued support to Primary Health Program at Cross River State.

To find out more about the project and Tulsi Chanrai Foundation write to info@tcfnigeria.org