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By: Amawu, Cletus Albert Amawu.
Media Volunteer, NRCS. CRS BRANCH.
The UN Refugee Agency (UNHCR), Nigerian Red Cross Society (NRCS), and State Health Sector partners have undertaken the 2023 Balanced Scorecard (BSC) Assessments of Primary Health Facilities in Ogoja, Boki, Ikom, and Etung Local Government Areas of UNHCR-supported Health Centres.
Deploying the UN key performance indicator assessment tools to enhance Health systems strengthening, the State Health Sector is requested for frequent supervision and monitoring of the Health Facilities as the only option to improve on the prevalence gaps noticed in the just concluded 2023 BSC that fall short of expectations compared to the previous year assessment records.
The thematic areas for the BSC Assessments cover five basic portfolios:
1. Services Provided.
2. Staffing and Coverage.
3. Equipment and Supplies.
4. Quality of Care and
5. Patients (Client’s) Satisfaction.
According to Madam Sally Enyin, Lead Assessor and Director, Community and Family Health Services in the Cross River State Primary Health Care Development Agency (CRSPHCDA),
“The Balanced Scorecard (BSC) Assessment is so key in the sense that it enables us as a State to know what partners are doing in essence.
“We are talking about evidence-based. It gives comprehensive details of what they are doing at facilities; the assessment is comprehensive and also helps us to know the gaps and proffer solutions for quality service delivery. It goes beyond the provision of drugs and manpower.
Comprehensively the facilities are accessed in different thematic areas, environment, health workers capacity that render the services, and the equipment drugs to drive this process.
It enables us to know what the healthcare workers are doing to fix the gaps from the side of the government to recommend for those that are engaged by the partners like the Nigerian Red Cross Society, and UNHCR the right human resource should be engaged to be able to take care and render different and quality services.
In her rating of Facilities: “Adagon Primary Health Centre is the highest client flow facility in Ogoja, and the managerial skills capacity of the officer in charge (OIC) is in question and overwhelmed to manage the facility; leadership-wise, and coordinating the affairs as it were is poor in services, documentation. On the part of the Community, they are doing well and have shown their general interest and commitment but we saw some decay, and broken equipment and these are never unconnected with the OIC handling of the overall facility. The human resource in the facility is fine; My recommendation is for capacity building and a swap of the Officer in Charge because some personnel are higher and more qualified than him.
“Generally, Ukende Health Centre is doing well in the environment, WASH and documentation are superb. The in charge is on her job and the staff are also on their job, bing cards are filled up to date unlike in Adagon PHC,
“In Bashu Health Centre, there are also human resource gaps. The right human resource for health is lacking and the right personnel are not engaged. The CHEW doing the work of the midwife lacks the prerequisites. My recommendations during the last BSC I remember recommending that the right and qualified personnel should be engaged. If you don’t have the capacity, what service will you render, definitely you are not going to render any good service. I noticed poor assessment of one of the patients, wrong diagnosis, and wrong prescription which is detrimental to the health of the client.
“The Bashua Health Centre, they are on their jobs with capacity, documentation, and services were right and there’s Community support also.
“And for Ikom Comprehensive Health Centre, the capacity of the government health staff is on top with many midwives, CHO, CHEWS, Pharmacist, and Laboratory Scientists, my only worry was my interaction with postnatal in terms of breastfeeding and there was no proper attachment was not there, but I mentored the mothers and most of the mothers did not do exclusive breastfeeding of 0-6 months and that was stressed and they promised to do the needful way forward, and another gap noticed was the OIC taking hold of the pharmacist responsibilities and having the drugs locked in her office. These were immediately sorted out, hence, advised that all drugs should move to the pharmacy.
On the performance-based financing (PBF) and Drugs Revolving Scheme, Madam Sally had this to say, “partners will not be here forever, and we emphasize that the seed fund given to facilities should be revolving so there will be no gap and stockout. The facilities should be able to take charge as partners’ funds are reducing and to be honest, there was not much of a gap here.
“The prevalence gaps noticed at the facilities were, the non-availability of some key equipment like sterilization, in some cases, you have the equipment but there is no human resource capacity to put it to proper use, The first is the capacity of the health workers, they should be training and re-training especially on the use of the equipment and on prescriptions too, like in Bashu, if the doctor is not always visiting there, no midwife, they should be somebody that will re-mo-mentor the personnel in cases they can not handle and get proper instructions on what to do, capacity building and the right human resource and integrated service delivery for basic knowledge,” she concluded.
On the objectives of the BSC Assessment, Mr. John Nyam, ATO Monitoring and Evaluation NRCS.Ogoja said “The Nigerian Red Cross Society is a humanitarian response organization and in this particular context we have funding from the United Nations High Commissioner for Refugees to provide services for Refugees and host Communities in some supported facilities where we have high refugee settlement.
“We as a matter of policy have a strategy to support government systems in a way of not creating our own parallel systems to support the systems that are on the ground to improve our quality of care to all beneficiaries and refugees alike. In that way the Nigerian Red Cross has provided staffing support to these facilities, provided equipment, and did some infrastructural upgrades it is only necessary that once in a while an evaluation takes place to see where things were and where things are going and the necessary improvements that can be done to improve quality of service.
“And so the Balanced Scorecard Assessment is an activity of the UNHCR. it’s an assessment that aims to identify the gaps to develop targeted recommendations related to the means of health management and service provision. It aims to monitor changes over time, to mobilize additional training and resources for technical support, and then document good practices along the way.
“The reason is we are serving people and it is only important that they give feedback and that is for patient satisfaction the aim of our intervention in health systems is to improve the quality of care and we can only measure that by assessing periodically and that is why the balanced scorecard is very important and necessary for the Nigerian Red Cross Society with support from the UNHCR has provided support in terms of infrastructure as well and it is also important in addition to the supportive supervision that the partner here Nigerian Red do to involve some stakeholders from the government whom this organisation is supporting to also see what is happening on the ground to see how the patients are treated and also get from the patients themselves how they feel about the services they are getting.
Mr. Nyam, said, “There’s a significant improvement. I think from inception we had a baseline and we have been able to improve so much on the services for facilities that were lacking we have seen significant improvement because there’s always a channel to give feedback on exactly what should be and what is not going on well so I am impressed with this one. We’ve seen significant progress and improvement,” he said.
The Assessment Team includes Madam Sally Enyin, Lead Assessor and Director, Community and Family Health Services in the Cross River State Primary Health Care Development Agency (CRSPHCDA). Mr. Saviour Igriga Department of Public Health Services, Cross River State Ministry of Health (CRSMH). Mrs. Rosemary Adie, Social Mobilisation Officer (SMO-Ogoja). John Nyam, Assistant Technical Officer (ATO) Monitoring and Evaluation, NRCS., Ogoja. Abiem Simon Aondoaver, ATO Mental Health, and Team Lead NRCS-UNHCR PROJECT Team Ogoja, and Mary Maipma, ATO Nutrition, NRCS, Ogoja.
The climax of the tour was client interviews at every facility with the Chairmen of Village Development Committees (VDC) refugee representatives, antenatal and postnatal mothers and host communities, and their Chiefs who appreciated both the UN Refugees Agency and the Nigerian Red Cross for their wonderful support and concerns for the health of Refugees and host Communities, WASH, provisions of equipment and the drug revolving scheme.
Some of the interviewees were Chief Mankong Stephen, (VDC Adagon) and Pastor Ngoe Thomas (VDC settlement Adagon). Chief Iyaje Iyeji (VDC Ukende) Ugbeche Fidelis Murphy. Mr. Ayaga Stephen (Refugees Reps.) Otu Emmanuel Ochang, Chairman (VDC Bashu), Kechi Peter Osung, Secretary-Bashu Youth Council. Engr. Denis Dan Mbia, Chairman (VDC Bashua), and Mr. Obashi Ernest, Chairman of Refugees Settlement, Bashua.
Also part of the Tour were Division Secretaries of NRCS Ogoja, Charles Ojong. Etung, Cosmas Eba, Ikom, Ojong Etta, Boki, Friday Okwo, and Comrade Amawu Cletus Albert, Media Volunteer, NRCS.

Amawu Cletus Albert Amawu

I'm a Journalist, Host/Producer of The Verdict, your voice of conscience on FAD FM 93.1, Calabar, Public Affairs Commentator, Social Change Agent.

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