BASICS-N PROJECT Community Partners for Health (CPH) Coalitions in Lagos, Nigeria 1994 – 1999 Sam A Orisasona Team Leader, Lagos Field Office

Order of Presentation Project Mandate/Tiltle The Critical Health Issues Core Processes Management Logistical Support Training Membership Characteristics of CPH Networking Accomplishments Sustainability Issues

Project Mandate/Tiltle

The Critical Health Issues

Core Processes

Management

Logistical Support

Training

Membership

Characteristics of CPH

Networking

Accomplishments

Sustainability Issues

The Critical Health Issues In 1990 immunization coverage in Nigeria approached the African target of 80% Since 1991, immunization efforts have slackened In 993, only 37% of children received all antigens by first birthday In 1992, USAID documented 29% children with valid full immunization coverage by 12 months In 5 LGAs where BASICS was to serve, immunization coverage was pegged at between 20.5% and 40.9% Physical accessibility was not much the problem, but, but lack of quality services by the public sector, Hence, BASICS was mandated to redress the problem

In 1990 immunization coverage in Nigeria approached the African target of 80%

Since 1991, immunization efforts have slackened

In 993, only 37% of children received all antigens by first birthday

In 1992, USAID documented 29% children with valid full immunization coverage by 12 months

In 5 LGAs where BASICS was to serve, immunization coverage was pegged at between 20.5% and 40.9%

Physical accessibility was not much the problem, but, but lack of quality services by the public sector,

Hence, BASICS was mandated to redress the problem

Project Mandate PROJECT : USAID/BASICS-N Child Survival PROJECT BASICS means Basic Support for Institutionalizing Child Survival, Arlington, USA USAID MANDATE : Find innovative ways to meet the needs of poor Nigerian children in urban communities of Lagos

PROJECT : USAID/BASICS-N Child Survival PROJECT

BASICS means Basic Support for Institutionalizing Child Survival, Arlington, USA

USAID MANDATE : Find innovative ways to meet the needs of poor Nigerian children in urban communities of Lagos

Core Processes Nigeria was decertified as a result of military perpetuation by the American Congress in mid 1990 UPSI – Urban Private Sector Inventory of CBOs and HFs in late 1994 (in 13 communities, 6 selected) in 1995 Selected communities where CPH were formed: Ajegunle, Mushin, Surulere, Makoko, Amukoko and Lagos Island Community Fora/meetings: 2 meetings held in each cluster area (concept of coalition for improved child care introduced for debate and acceptance as alternative to increasing childhood morbidity and mortality) Formation of 6 CPH by interested partners (by end 1995) and development of MOU (structure, leadership and responsibilities, reduced cost of treatment/CBO default prevention/management arrangement) Constitution development CPH NGO Community-based Registration by CAC (6 CPH) Setting up of 6 CPH Secretariat. Documentation by 1997 (provided lessons for Kano, Abia States) – a total of 16 CPH set up

Nigeria was decertified as a result of military perpetuation by the American Congress in mid 1990

UPSI – Urban Private Sector Inventory of CBOs and HFs in late 1994 (in 13 communities, 6 selected) in 1995

Selected communities where CPH were formed: Ajegunle, Mushin, Surulere, Makoko, Amukoko and Lagos Island

Community Fora/meetings: 2 meetings held in each cluster area (concept of coalition for improved child care introduced for debate and acceptance as alternative to increasing childhood morbidity and mortality)

Formation of 6 CPH by interested partners (by end 1995) and development of MOU (structure, leadership and responsibilities, reduced cost of treatment/CBO default prevention/management arrangement)

Constitution development

CPH NGO Community-based Registration by CAC (6 CPH)

Setting up of 6 CPH Secretariat. Documentation by 1997 (provided lessons for Kano, Abia States) – a total of 16 CPH set up

Management Needs assessment/Work plan development sessions Training in Democracy and Governance Establishment of women’s empowerment committees Establishment of youth wings Establishment of savings and loans cooperatives Establishment of micro-credit scheme Design, printing of letterheads, brochure for identity Promotion of inter CPH collaboration/competition Capacity building on M & E skills

Needs assessment/Work plan development sessions

Training in Democracy and Governance

Establishment of women’s empowerment committees

Establishment of youth wings

Establishment of savings and loans cooperatives

Establishment of micro-credit scheme

Design, printing of letterheads, brochure for identity

Promotion of inter CPH collaboration/competition

Capacity building on M & E skills

Logistical Support Provision of megaphones for awareness campaigns Provision of cold chain equipment and materials for immunization Provision of environmental sanitation tools for sanitation activities Provision of start-up stock of office supplies Gifts of used vehicles, office furniture and computers by USAID (some were sold – e.g. Surulere – ($3,100) Registration of partners (HF & CBOs) Raffle ticket & appeal funds Support for external audit of CPH accounts

Provision of megaphones for awareness campaigns

Provision of cold chain equipment and materials for immunization

Provision of environmental sanitation tools for sanitation activities

Provision of start-up stock of office supplies

Gifts of used vehicles, office furniture and computers by USAID (some were sold – e.g. Surulere – ($3,100)

Registration of partners (HF & CBOs)

Raffle ticket & appeal funds

Support for external audit of CPH accounts

Training Needs Assessment for carrying out child and community health programs Operationalizing the cost of reduced health care cost on credit/building CBO Capacity to support failed individuals Technical training on childhood target diseases: Malaria, Diarrhea & 6 immunizable childhood diseases Training of TBAs H/Education materials development

Needs Assessment for carrying out child and community health programs

Operationalizing the cost of reduced health care cost on credit/building CBO Capacity to support failed individuals

Technical training on childhood target diseases: Malaria, Diarrhea & 6 immunizable childhood diseases

Training of TBAs

H/Education materials development

Membership In Lagos: 700 partners identified (395 CBOs & 330 HFs of which 279 interviews were completed, only 90 out of CBOs reported involvement in any health activities-71 specifically mentioned immunization) Community fora were organized around potential HF and CBOs that were likely to form dyadic partnership- minimum of one HF and one CBO within a larger CPH Community fora was held in (community halls, HF and clinics, schools, religious buildings) CPH Board Formation Formation of fund raising committee Formation of finance & Budget committee etc

In Lagos: 700 partners identified (395 CBOs & 330 HFs of which 279 interviews were completed, only 90 out of CBOs reported involvement in any health activities-71 specifically mentioned immunization)

Community fora were organized around potential HF and CBOs that were likely to form dyadic partnership- minimum of one HF and one CBO within a larger CPH

Community fora was held in (community halls, HF and clinics, schools, religious buildings)

CPH Board Formation

Formation of fund raising committee

Formation of finance & Budget committee etc

Characteristics of CPH Mushin CPH Eligible groups - 40 Reached/Contacted - 33 Attended Fora - 23 Joined CPH - 8 Joined (not identified) - 6 ENTIRE CPH 6 CPH initially comprised of 72 groups (80%) CBOs Drop out – 2 CBOs, relocation of a dyad AJCPH to AMCPH 2 years later, membership increased to 137 groups

Mushin CPH

Eligible groups - 40

Reached/Contacted - 33

Attended Fora - 23

Joined CPH - 8

Joined (not identified) - 6

ENTIRE CPH

6 CPH initially comprised of 72 groups (80%) CBOs

Drop out – 2 CBOs, relocation of a dyad AJCPH to

AMCPH

2 years later, membership increased to 137 groups

Networking Inter-CPH meetings, programs, and joint programs LGA (supplied trucks for refuse collection) State MOH (annual immunization campaign) and Women Affairs (women empowerment-Mock Democracy Parliament Program) Local schools International donors/Agencies UNICEF (All registered, collected 36,000 ORS for cholera emergency response) Ability to response to emergency situations in all the communities by 1997 Full program implementation by 1997 Youth networking on week-long HIV/AIDS campaign, and “I am pregnant” - AJCPH

Inter-CPH meetings, programs, and joint programs

LGA (supplied trucks for refuse collection)

State MOH (annual immunization campaign) and Women Affairs (women empowerment-Mock Democracy Parliament Program)

Local schools

International donors/Agencies

UNICEF (All registered, collected 36,000 ORS for cholera emergency response)

Ability to response to emergency situations in all the communities by 1997

Full program implementation by 1997

Youth networking on week-long HIV/AIDS campaign, and “I am pregnant” - AJCPH

Accomplishments Increased immunization Cleaner environment Making health care accessible and affordable to members Community coalition was extended to address other issues e.g. elections, politics, education etc CPH model was an innovative way to involve the private sector in reaching the poor with quality health and preventive services CPH model actually dispelled rumors that community health coalitions are impossible in urban areas CPH was replicated in Kano and Abia States Lessons learned from CPH was transferred to the design of another model (CAPA) that works with government and the people opon transition to democracy

Increased immunization

Cleaner environment

Making health care accessible and affordable to members

Community coalition was extended to address other issues

e.g. elections, politics, education etc

CPH model was an innovative way to involve the private sector in reaching the poor with quality health and preventive services

CPH model actually dispelled rumors that community health coalitions are impossible in urban areas

CPH was replicated in Kano and Abia States

Lessons learned from CPH was transferred to the design of another model (CAPA) that works with government and the people opon transition to democracy

Sustainability Issues Ability to: Govern themselves including managing of resources and conflict resolutions Generate resources to maintain programs on a continuous basis Plan and implement programs independently Link with other development agencies and donors

Ability to:

Govern themselves including managing of resources and conflict resolutions

Generate resources to maintain programs on a continuous basis

Plan and implement programs independently

Link with other development agencies and donors

Thank you

References William R. Brieger et al: Community Partners for Health: Urban Health Coalitions in Lagos, Nigeria International Quarterly of Community Health Education 2000-01;20(1):59-81 Silimperi DR et al: Lagos Community Partners for Health: Innovative Private Sector Partnership Promote Child Survival . Arlington BASICS (USAID), 1997

William R. Brieger et al: Community Partners for Health: Urban Health Coalitions in Lagos, Nigeria International Quarterly of Community Health Education

2000-01;20(1):59-81

Silimperi DR et al: Lagos Community Partners for Health: Innovative Private Sector Partnership Promote Child Survival . Arlington BASICS (USAID), 1997