USAID Cluster Stresses Need for Adequate Supervision of PHCs for Improved Quality Service Delivery

Segun Awofadeji in Bauchi

USAID Palladium-funded project, Health System Strengthening Cluster has observed that if all Primary Health Centres (PHCs) in Bauchi State are adequately supervised, it would guarantee quality healthcare service delivery in the state.

This was as the USAID Cluster urged the Bauchi State Government to prioritize the release of funds in the budget line to the primary health care facilities to achieve universal health coverage particularly in the rural communities of the state.

The Cluster is implementing the Scale project, a USAID-funded 5-year project (Oct. 2020-Oct. 2025), implemented by Palladium in collaboration with Nigeria Resource Partners (RPs).

The project is titled “Improved Quality Healthcare Service Delivery through Integrated Supportive Supervision (ISS)”.

Making the observation while addressing journalists at the NUJ Secretariat, Bauchi, weekend, chairman of the Cluster, Ogadinma Nkem Ogbonnaya, however lamented the decay in the rural health care facilities.

According to him, “some facilities are being captured under major PHC under facility per ward while others were left behind. Many of the small PHCs do not have the required number of skilled workers and necessary equipment to deliver.

“We are calling on government to release the fund for the project as it is stated in the budget line to carry out this integrated supportive supervision. We are going to carry out a robust data collection exercise where we will document the inventory of every facility. This will help the government to what is needed in particular area and promptly respond.”

He disclosed that the Cluster comprises six Civil Society Organizations (CSOs) across the country – viz; Life Transformation for Africa Initiative (LIFT4AFRICA), Council for Affirmative Action (COFA), Women with Disability Integrity & Development Initiative (WDIDI), Bauchi State Network of Civil Societies (BASNEC), She-Alert Care Foundation (SHE-ALERT) and Better Life Restoration Initiative (BERI) serving as the anchor organization.

According to him, the advocacy focus is on the release of funds budgeted for Integrated Supportive Supervision (ISS) in the 2024 Budget of Bauchi State, Expansion of the Integrated Supportive Supervision Technical Working Group (ISS-TWG) to include other critical stakeholders like ward development committee and the private sector and establishment of a private sector engagement unit in the PHC department of LGAs.

He further explained that Integrated Supportive Supervision (ISS) is an intervention that facilitates quality improvement by ensuring adequate oversight as well as skills and knowledge transfer to health care service providers which has been accepted, tested and proven to enhance the performance and effectiveness of health care workers.

The benefits of Integrated Supportive Supervision (ISS) include strengthening of health care system, enhances quality service delivery, improves performances, encourages open, two-way communications, enhancing team building spirit and problem solving.

On the key issues highlighted by the PEA on ISS, he said that the current structure and placement of ISS is suboptimal and, therefore, limits the capacity of integrated supportive supervision to effectively engage through a sector-wide approach for effective implementation.

Another is domestic financing support for Integrated Supportive Supervision is inadequate and there is high dependency on donor funding as over the years, many health programmes have been heavily funded by donors supporting integrated supportive supervision activities, tuberculosis (TB), HIV etc.

His words: “Although donor support is important, this is mostly unsustainable and has debilitating effects on ISS continuity.

“High cost of fuel and transportation is negatively impacting ISS activities in all the target states. The current hike in fuel prices and its attendant high cost of transport has negatively affected the frequency and coverage of primary healthcare centers, especially health facilities located in hard-to-reach communities.

“Limiting supervision activities to main primary healthcare centers of every ward: Supervision activities are conducted more in those facilities that receives the basic healthcare provision fund and other interventions, thereby leaving out the remaining health clinics and health posts.”

Another issue is inadequate trained and certified supervisors and dearth of data collection tools.

On policy alternatives, he said that, “Though the National Basic Healthcare Provision Fund (NBHCPF) provides funding and supervision of 323 main PHCs in the State. This however, is grossly inadequate because the state has over 1300 PHCs. The reliance on donors funding in conducting supervision is unsustainable.

“The non-inclusion of private sector partners in funding and supporting ISS activities in the State, is robbing the state off valuable resources. Finally, the nonexistence of a Technical Working Group (TWG) to plan and implement ISS activities in the state is having a negative impact on ISS activities.”

To ensure quality healthcare service delivery, facilitate sustainable knowledge transfer and regular mentorship of healthcare service providers, the cluster recommended that there should be creation of a budget line for Integrated Supportive Supervision activities in the 2025 budget of the state.

The cluster further recommended the establishment of a TWG to support the ISS activities in the state. Establishment of Private Sector Engagement Unit in the Primary Healthcare Department of Local Government Areas to assist in mobilising resources for ISS activities and Integration of all health facilities supervision activities to save cost