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How Uduaghan Has Revolutionised Healthcare Delivery - Otumara
09 August, 2013
No man is truly rich unless he is healthy – ancient African Proverb.

This proverb, better still its essence, typifies the importance of good health – at least consistent good health – in the life of an individual or even a community. Since individuals constitute the community which quality and tempo of development is inextricably tied to the health of its constituent individuals, health is, by good reasoning, a crucial factor in the growth progress of any community. This is, ultimately, the quality of life the workforce (which is determined largely by the health of its human constituents) determines the quality of goods and services any, organization or society can offer at any one time.

The fact of the overall importance of quality health among its citizenry is not lost on the Dr Emmanuel Uduaghan administration, which has, in pursuit of this, entrenched several earth-shaking schemes/programmes to that effect. In all, the several programmes/schemes aim at ensuring that citizens have high quality life via easier access to quality health care at optimal cost-efficiency. These programmes/schemes, as indeed all other activities of the government in the health sector, are handled by the State Ministry of Health, which Commissioner, Dr Joseph S. Otumara, recently briefed the media on the activities of the government in the sector, in the ongoing Mid-term Ministerial Media briefs.

Responsibilities/Goals
The Ministry has responsibility for the formulation, development and implementation of health policies/programmes: administration of public health institutions; management of healthcare training institutions; registration of private/voluntary medical/healthcare agencies; enforcement of standards of practice; promotion of traditional medicine, primary health care, and disease control as well as supervision of the Specialist/University Teaching Hospital in the state.
The overall goal of the government is to enhance the quality of health (and hence of life) of Deltans by the effective significant reduction of mortality and morbidity via the provision of quality, cost-efficient health care services to the public.

Achievements
(a) Free Maternal Healthcare Programme
Launched at the Central Hospital, Ughelli, on November 2007, by Governor Uduaghan, this programme aims at whittling the incidence of maternal mortality in the state, and hence, enable the state attain the Millennium Development Goal (MDG) of Wealth for All by 2015, the target date. Initially meant to address only ante-natal care (ANC); deliveries (including Caeserean Section) and essential laboratory tests, it has been expanded to include ectopic pregnancies, blood transfusion and complications related to abortions.

As a result of the huge medical and financial relief it offers patients, the patronage of this programme has been tremendous. For example, since its inception, it has recorded a total of 278, 484, ANC bookings; 919, 248 Routine ANC; 127, 849 deliveries; recorded 44/1,000 births perinatal deaths;; 407 maternal deaths and a maternal mortality ratio of 244/100,000 live births. The prevalence rate of the Human Immune Deficiency Virus (HIV) is put at 2.9 per cent.

In terms of sheer statistics, from the period, (2007 to 2012) a total of 254,254 bookings was recorded; Routine ANC equaled 836, 544, while Post-Natal Care equaled 32,954 cases. Also during the period, a total of 116,504 and maternatal deaths 407 cases.
The Uduaghan administration, in pursuit of the programme, committed N1.8 billion on the programme.

Free Rural Health Scheme
Since 2007 when it was introduced, this scheme has become a crucial tool for the enhancement of the health of Deltans. For instance, a total of 97,678 persons had so registered under the scheme up to the 2012 fiscal year which officials/operators have so far visited 443 communities. General surgery cases equalled 1,444;; Obstetrics and Gynaecology cases were 360, while Opthalmic surgeries totalled 2,562. There were also 2,055 dental cases and 4,165 cases of immunization. Dr Otumara put the HIV prevalence at 2.9 per cent. He added that, in all, a total of N570 million has been expended on the programme which he classified as a huge success.
Free Under-Five Health Care
Without an iota of doubt, the child is mankind’s only guarantee for the future. This is because he is the only assured continuation of the human tree – the ‘seed’ that will become the next generation, so to speak. In this vein, it is imperative to give primus attention to ensuring the total well-being of the child.
In pursuit of this desire, the state government, introduced the free under-5 healthcame programme, under which children under five years of age access quality healthcare, free of charge. The philosophy of this is to ensure a successor generation that is essentially healthy, by enabling them access quality healthcare at public expense. The programme was launched on May 27, 2010 by Governor Uduaghan. Since its historic birth, this revolutionary healthcare programme, a total of 669,549 persons had been attended to, with a total death incidence of 1,347, which marks out at 0.20 per cent. Of the 669,549 beneficiaries, 43,654 were admitted to hospital/clinic, while 695,895 were treated as out-patients. The impressive thing is not only on account of the low death rate which has helped address the MDG-related issue of infant mortality/morbidity, but also on account of the increasingly progressive numerical attendance: from 82,486 in 2010 to 235,957 in 2011 and 351,106 in 2012 (the 2013 date is still in the works). The implication of this set of data is that, across all divides, the public has bought into the philosophy of this programme.
A breakdown of the factors underlying the incidence of deaths showed that malaria topped the chart with 27 per cent, followed by neonatal sepsis (12 per cent) as well as severe anaemia; Gastro enteritis and birth asphysia, at 7 per cent each. Others were Respiratory Tract Infections (6 per cent); Febrile convusion (4 per cent); Protein Energy Malnutrition and Meningitis (3 per cent each); Tetanus (2 per cent) and Prematurity and Surgical Complications (1 per cent each). Others made up the remaining 20 per cent, according to Dr Otumara, who also paid that the government had expended N1.2 billion on the programme. All three foregoing programmes/schemes – free rural care programme, free under-five healthcare programme and the free maternal healthcare programme – are geared towards the realization of the human capital element of the three-point agenda of the state government.

Infrastructure Development

It is said that even the best services run on adequate infrastructure. That is the core reason the Uduaghan administration has been laying critical infrastructure to propel its magnificent healthcare delivery mechanism. Elements of these infrastructure are:

DELSUTH, Oghara
This top-flight medical facility ranks amongst the best in Africa, not only in terms of facilities it houses but also on account of its high calibre manpower. Encouraged by the state government, the management of the hospital has been able to coordinate men and materials to offer Deltans (as indeed others), quality medical facilities, including in areas once considered outside of the competence range of our locally available personnel. Estimated at N17.66 billion (out of which the Uduaghan administration paid about N8 billion), it was commissioned on June 19, 1010 by President Jonathan. It is now recording breath-taking feats in medicine, including in delicate areas, including knee replacement surgery, and minimal invasive surgery and is set, sooner than later, to begin kidney transplantation and other landmark medical procedures.
Other Hospitals/Health Centres
In an effort to put its health facilities in optimum – qualitatively and quantitatively – the Uduaghan administration, since 2007, to 2011, awarded contracts for the construction/rehabilitation/renovation of 390 projects, at the primary, secondary and tertiary levels. A total of 248 have been completed, leaving 52 at various stages of completion. According to Dr Otumara, N4.6 billion has been paid for work in this respect, and hospitals completed in this regard include those at Uzere, Ubulu-Uku, Onicha-Olona, Aboghorodo and Ogiregbene. A state-of-the-art Mobile Field Hospital, has been procured and put to effective use, while Intensive Care Ambulances will soon be rolled out to strategic points on the highways for emergency services.
The administration, also during the period under review, built/rehabilitated 264 Primary Healthcare Centres (PHCs) at a total cost of N789 million.
Yet other core infrastructure delivered in the sector include Eku Baptist Hospital (which is being repositioned for enhanced efficiency); Maternal/Child Care Hospital, Warri; Modern Office Complex, Central Hospital, Warri; upgrade of Central Hospitals in Agbor, Ughelli, Sapele and Warri. Provision of oxygen plant and rehabilitation of medical gases pipeline system at the Central Hospitals in Agbor, Ughelli and Warri, as well as ongoing maternal and child care hospital at General Hospital, Ekpan. Besides, the Central Hospital, Asaba, is being remodeled to befit a modern hospital in the state capital.

Kits/Equipment
To ensure that its health centres perform optimally, the government has not only provided them with quality manpower, but also state-of-the-art equipment in respect of which it has spent N5.5 billion.
Standard Enforcement
Part of the responsibilities of the Ministry are the monitoring inspection and registration of private health institutions in the state. The Ministry is also responsible for the renewal of the operational certificates of existing health centres. The overall goal in this regard, is to ensure that quackery and substandard practices are eroded. In pursuit of this goal, the Ministry, via its Task Force on the subject, has visited 129 facilities, out of which 43 were sealed up for quackery, while 36 others were ‘warned’ to be of good conduct.

Medical Assistance/Refund of Medical Expenses

As part of its efforts at ensuring consistent good health for the people of the state, the government has not only introduced and implemented its free healthcare policies, but has, quite wisely, augments them with a policy under which, visits via itsMinistry of Health, it offers material and other forms of assistance to those truly in need. A total of N1.4 billion has so far public servants for their medical expenses, in line with laid down regulation.

Drug Revolving Fund (DRF)
A core element of the Delta State Government’s Health Care delivery mechanism is its drug revolving fund. This is saddled with the responsibility for ensuring the continuous procurement of high quality drugs and other pharmaceuticals and ensuring that they are readily available at every dispensing point in the service delivery chain, at cost-efficient prices.

Dr Otumara said, at the media brief, that “the efficient management of the Drug Revolving Fund, over the years, has ensured that the hospitals have been able to meet patients’ drug requirements without any further infusion of new capital by the government.” According to him, the value of drugs/dressings and other pharmaceuticals supplied during the period equal N3.9 billion, while the corresponding revenue received during the period was N2.12 billion. The figures are inclusive of the supplies/receipts in respect of the three free health programmes of the administration.

But that is not all of the good news. Conscious of the fact that a fake/adulterated/substandard pharmaceutical product, on ingestion, is poison in effect, the government set up a quality assurance in the DRF. This is to ensure that drugs meet global standards of quality (so-called pharmaceutical standard). In the exercise of its mandate in this regard, the unit, in 2012, sieved nine drugs that failed the quality test from the system. The nine drugs were part of the 62 investigated for quality; the 53 others scaled the test hurdle.

Other Health Parastatals
The Hospital Management Board (HMB)
This board manages the 62 public hospitals in the state which are grouped into 11 medical zones for administrative ease. There are six Central Hospitals – Agbor, Ughelli, Sapele, Warri, Oleh and Kwale, with the first four, being well equipped and generally adequate, comparable to teaching hospitals. The Central Hospital, Warri, for instance, is accredited by the National Post-Graduate Medical College of Nigeria and the West African College of Surgeons, for residency training in Obstetrics/Gynaecology and Anaesthesia, with a joint approval with DELSUTH, Oghara, on the training of paediatricians from the West African College of Physicians. Each of the 11 medical zones has a Management Committee which enforces discipline among staff.

State Primary Health Care Development Agency
The State Primary Health Care Development Agency (SPHCDA), is, as the name implies, in charge of the development of PHCs. The SPPHCDA has carried out successful immunization coverages in the state; deployed and Community Health Extension Workers (CHEN), to inaccessible health centres, or without resident staff, held the unimmunized children’s project.

Onchocerciasis: Enter SPHCDA
Between January and December, 2012, the SPHCDA trained a total of 3,964 persons in different categories – community drug distributors (2,479); community supervisors (1,043) and health workers. Also, a total of 639,203 persons were treated with 1,453,000 tablets of Mectizen. Besides, a total of 119,203 persons treated with 222,002 tablets of prazinquertal during the periods.

A far-fetched survey for the prevalence of endemicity of loaloa was carried out in 43 villages in council areas randomly selected in Bomadi; Ethiope East; Ethiope West, Isoko North, Okpe, Patani and Sapele.

Disease Surveillance/Outbreak/Investigation

During the period, the Ministry also held regular meetings with Disease Surveillance and Notification Officers (DSNOs) and the weekly review of The Integrated Disease Surveillance and Response (IDSR) forms 002 data and monthly review of IDSR 003 data and sending of same to the Federal Ministry of Health as well as the distribution of Personal Protective Equipment (PPE) and lassa Fever Drug, Ribavarin.

It equally conducted investigation into the reported outbreaks of Lassa Fever in Warri South Council Area, and suspected outbreak of measles in Oghara; Cholera in Ethiope East; Lassa Fever in Oshimili North Council Area; Neonatal Tetanus in Eku, Ethiope East; Gastro-enteritio in Isheagu in Aniocha South; measles in Ethiope East and in Oririokpe and Okwejeba in Okpe Council Areas.

Interventions
The Ministry also engaged in immunization; Vitamin ‘A’ supplementation; Iron Folate for pregnant women; distribution of Long Lasting Insecticide Nets (LLINs) and the administration of Sulfadoxine-Pyremethanine (SP) in pregnancy; de-worming of children; family planning, birth registration as well as the key household practices, including exclusive breastfeeding and complementary feeding.

In all, hundreds of thousands of Deltans benefited from the interventions of the Ministry between 2009 and 2011, in such specific areas as Oral Polio vaccine (OPV); Diptheria (Dpt); Measles, Yellow Fever, Tetanus Toxoid, Vitamin “A’ supplementation; LLINs, ANC-Iron/Folate; Family Planning; SP (in pregnancy); De-worming, etc. The result is that our children, mothers and household members are now healthier and more productive.

The Future
It is without doubt that even though Commissioner Otumara was silent on that, the Ministry has some few challenges, just like any other human institution.

The good news, however, is that the strategic ministry and its management, starting from Dr Otumara himself, are fully conscious of their strategic place in the realization of the golden dream that underpins the three-point agenda of the state government and are determined to consistently contribute their fair quota by their consistent implementation of all policies and programmes set forth in that regard.

Good to know this facts.

Delta and Uduaghan is indeed wasking stronger...good strides !