In 2011, Nigeria instituted a national policy, ‘bringing PHC under one roof’ to integrate management of Primary Health Care and end fragmentation in the health sector. The policy built on the experience of the Jigawa State Gunduma Health System and the restructuring experiences of other states.
Health Partners International helped develop and execute these far-reaching governance initiatives and health system reform to address fragmentation and dysfunctionality. These include the Gunduma structures in Jigawa and Primary Health Care Boards in a number of other States including new legislation and regulations.
The Gunduma Health System is the state’s own version of the district health system recommended by the World Health Organisation (WHO). This integrated system brings primary and secondary care services together under one management structure.
The reform in Jigawa was much needed. As a result of fragmented, ineffective health care delivery, communities had lost trust in public health services, and this was reflected in the very low rates of use of services and poor health outcomes.
The process of change was very carefully managed with the support of the Partnership for Transforming Health Systems 1 (PATHS) programme funded by DFID and involved a long process of engagement with experienced health managers from both secondary and primary care to own and drive the process and consultation with users of health services, the highest levels of government and political and religious leaders.
In Jigawa, achievements included the establishment of an integrated and decentralised health system with responsibility for all aspects of service delivery transferred to the Gunduma Management Team. This process created the need for the ministry to reposition itself, taking on a stewardship role, with considerably more focus on policy development, macro-planning, regulation and sector financing.
The adoption of the Gunduma Health System in Jigawa State has demonstrated that one way forward for effective health services delivery is the integration of both secondary and primary health care. It has also demonstrated that with goodwill and commitment to change, health sector institutions can be streamlined to provide better services for people and ultimately improved health outcomes.
Across other states, in consultation with the Jigawa, Yobe and Zamfara State Offices of the Special Advisor, Health Partners International provided technical assistance in developing:
- The Gunduma Health Systems Law, 2008
- Yobe State Primary Health Care Development Law, 2010
- Zamfara State Primary Health Care Management Board Law
- The development of regulations to accompany each of the Laws
- The Gunduma Health Systems Act, 2008 and regulations thereunder (2006 – 2008)
Additionally, Health Partners International supported the establishment of the State Primary Health Care (PHC) Development Board in Jigawa, Yobe and Zamfara States and the process for the creation of the PHC Management Board in Zamfara State.
Further work was also done in developing district health system legislation with the Enugu State Health Ministry in Nigeria (2004) and at the federal level in reviewing legal frameworks and supporting the overall process of institutional strengthening of the National Agency for Food & Drug Administration and Control (NAFDAC).