Over the years, the Nigerian health system especially the public hospitals have become weakened as a result of several factors ranging from poor funding poor planning, lack of will and commitment on part of Government and health care workers to effect change. This has led to dilapidation and reduction in capacity to provide quality care and services to patients, especially as regard Family Planning. NURHI discovered at the beginning of the project that there were lots of incorrect assumptions and information about status of health facility and utilization in relation to Family Planning.
The Government did not have an accurate list of private health facilities. Most hospitals did not have National Health Management Information System records or an efficient and adequate recording keeping methods or materials. This situation revealed the need to strengthen the health systems capacity to provide quality FP services. The HSS activities comprised of training and re training HCWs on FP and HMIS, providing materials for HMIS and strengthening commodity logistic systems, supporting HCWs to provide quality services through ISS and improving the physical environment where FP services were provided ; the 72-Hour Clinic Makeover.
The concept means family planning clinics, Primary Health Care centres and sometimes other integration sites that promote family planning information, counseling and services – i.e. antenatal care (ANC), delivery, post-natal care (PNC), immunization clinics, post abortion care (PAC), HIV counseling and testing (HCT), and Antiretroviral Therapy services are set up (renovated, refurbished and equipped) for optimal family planning service provision using the National Standards of Performance for Family Planning Services. Clients attending these integration points would be referred to the family planning clinic especially in NURHI High Volume Sites (HVS). The NURHI Integration Strategy was revised accordingly.
The entire implementation of this concept is carried out within a time frame of 72 hours from after work on a Friday to before work the following Monday. The 72-Hour Clinic makeover is mostly carried out in facilities where NURHI has trained health care workers and ensured good record keeping, provided materials for referrals, job aids SOPs, IEC etc., it supports the facility and community members to “make-over” the facility. A process of assessment prioritization and cost effectiveness is ensured through direct labor, which brings about community involvement. The “72-Hour Clinic Make-over” exercise begins with a planning session with community members and service providers agreeing on what will be done in a chosen facility. By the close of business on a chosen Friday, repairs, renovations and installing of equipment are carried out through the weekend, and by Monday morning the clinic reopens in a renewed state, ready to provide optimal family planning services. The intent is to make family planning services more inviting for clients, thereby increasing utilization.
This concept was undertaken starting with the first five high volume sites in each NURHI initial cities (Ibadan; Kaduna; Ilorin and FCT).
In Nigeria top government functionaries (either the first lady, commissioner for health or LGA chairman commissions or launches the facility after renovation.
In the fourth year of the project, NURHI modified its 72-Hour Clinic Make-cover concept to Clean, Repair, Use and make Functional (CRUF) existing equipment just as a Fairy would wave its wand (FY). This was necessitated by the PIP findings, which identified that some equipment in some facilities just needed minimal repairs, cleaning and refurbishing.
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