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COMMUNIQUE FROM THE 4TH EDO STATE COUNCIL ON HEALTH MEETING HELD AT BISHOP KELLY PASTORAL CENTRE, AIRPORT ROAD, BENIN CITY ON 9TH – 11TH JULY, 2009

THEME: PARTNERSHIP FOR EFFECTIVE PRIMARY HEALTH CARE

The State Council on Health (SCH) is the highest advisory body on health matters in the State. It brings together all the major stakeholders in the Health System and provides a forum for broad based consultations, joint planning, mutual support and consensus building in pursuit of better health for the people. It is an assembly of the Hon. Commissioner for Health, the Permanent Secretary, Heads of all Departments and Parastatals under the State Ministry of Health, Chairmen of the Local Government Councils, their Supervisory Councilors for Health, State Traditional Medicine Board, Chief Executives of Federal Health Institutions in the State, State Ministry of Local Government, Non-Governmental Organizations (NGOs), Voluntary Health Agencies in the State, all Health Professional Bodies registered in the State, and all National and International Development Partners. The Hon. Commissioner for Health is the Chairman.

The 4th Edition of the State Council on Health was held at the Bishop Kelly Pastoral Centre, Airport Road, Benin City from 9th – 11th of July, 2009. It was chaired by Dr. Moses Momoh, the Hon. Commissioner for Health, Edo State. A total of three hundred and ninety-two (392) participants graced the occasion including Commissioners, Local Government Chairmen, Special Advisers and Permanent Secretaries. The meeting successfully brought together participants from the different tiers of Government, Ministries, Departments, Agencies, Professional Bodies, Development Partners, and other NGOs.

was declared open by the Governor of Edo State, Comrade Adams Aliyu Oshiomhole represented by his Deputy, Dr. Pius Odubu. In his address the Governor dwelt on the appropriateness of the theme as it related to the appalling health indices of Edo State. He expressed the commitment of his administration to reversing and improving the situation by amongst other things, strengthening the health system and the vigorous pursuit of the Millennium Development Goals.

In the welcome address by the Permanent Secretary, Ministry of Health, Dr. I.U. Omoike, he drew attention to some current avenues for joint planning and programming by the three tiers of government which include:-

	The National Strategic Health Development Plan which is expected to be a harmonization of Federal, State and Local Government health plans and a basis for national ownership, resource mobilization and accountability for all stakeholders in the health sector.
	He also highlighted the seven point agenda, vision 20-2020 and the Millennium Development Goals (MDGs) as basis for common planning for the good of our nation, state, and people.

The keynote address was delivered by the Hon. Commissioner for Health who traced the historical origin of Primary Health Care (PHC) as the foreground to the problems and challenges of PHC in the State as well as envisaged solutions. He emphasized the need for coordination and partnership, provision of adequate infrastructure and manpower especially within the setting of the Ward Minimum Health Care Package.

Goodwill Messages were received from Stakeholders including the WHO, National Primary Health Care Development Agency, Local Government Chairmen, Professional Associations, Pharmaceutical Companies, International and National Partners, and Donor Agencies.

Memoranda were received from the Ministry of Health, Professional Associations, Chairmen of Local Government Councils, Development Partners and Federal Agencies.

Opportunities were also given to NGOs such as Society for Family Health, Pathfinder International, Amen Foundation and Rotary to make presentations. Major thematic papers were delivered on:

	Human Resources for Primary Health Care – The Challenges
	Nigeria Federalism and The Health Sector
	Partnership For Effective Health Care Delivery

After deliberations, the Council arrived at the following observations, resolutions and recommendations.

I Manpower and Other Resources for PHC

1	Council noted the dearth of the right caliber, cadre and number of staff for service delivery especially at PHC level. Local Government Service Commission, Local Government Councils (LGCs) and State Ministry of Local Government were asked to adopt and apply the National Human Resources for Health Policy as it concerns PHC staffing - nurses/midwives, community extension workers and other cadres to allow effectiveness, quality and 24-hour coverage.
2	Council resolved that Medical Officers of Health/PHC Coordinators should be encouraged to obtain a Masters in Public Health (MPH) as a way of improving manpower proficiency at the Local Government levels. Accordingly, it recommended that preference is to be accorded candidates with MPH during recruitment exercise for PHC Coordinators/Medical Officers of Health at that level of care.
3	The SCH recommended a new “standard of completion” that links construction of more PHC Centres by Local Government Councils (LGCs) to guarantees of staffing, equipment, and sustainability. It therefore further recommended to the LGCs to avoid the construction of new PHC Centres until existing ones are adequately staffed, equipped and enabled to function properly.
4	Council further recommended that at least one Pharmacist and one Laboratory Scientist be employed in the service of every Local Government Area while a Pharmacist Technician should be included in the staffing of every health centre.
5	In order to ensure skilled birth attendance for pregnant women and to reduce infant and maternal mortality rates, the SCH recommended that Local Governments Councils should retain some of the Midwives posted to them under the one year mandatory midwifery service and the forthcoming Midwifery Service Scheme (MSS).
6	SCH noted the differences in the remuneration for health staff between the State and Federal establishment and recommended that the disparity be redressed in order to enable the State and LGCs attract and retain young skilled expertise to the State and Council public health service.
7	Council further noted that frequent transfers of trained staff away from the programmes for which they have been trained are obstacles to programme effectiveness especially in HIV/AIDS Control. Council recommended that such actions be avoided.

II Partnership for PHC

1	Council enjoined Local Government Authorities to commence participation in the National Strategic Health Development Plan by submitting relevant data to form part of the Edo State Strategic Health Development Plan
2	It also resolved that the State and Local Governments should accelerate the process of keying into NHIS project or set up a state scheme, if necessary
3	The free anti-malaria scheme for pregnant women and under 5 children in Edo State was commended by Council and sued for its sustenance. To this end, Local Governments Councils were advised to key into the project to enable it permeate to the lower levels of care.
4	Council noted and commended the support for PHC provided by the Health System Development Project (HSDP) and recommended that the LGCs should ensure effective management, ownership and sustainability of the completed PHC centres in their respective domain.
5	Council resolved that the State Government should continue to be an active contributor in Public-Private-Partnership (PPP) in pursuit of the health of the people of Edo State by providing the enabling environment for growth of such partnership.
6	It further noted that Public-Private-Partnership with Private Practitioners of medicine would enhance the extension of needed health care to areas of dire need.
7	The SCH recommended increased support to the LGAs by all stakeholders to enable them prosecute PHC activities effectively.

III. Drugs and Drug Supply

1	It was also resolved that the LGAs should make Essential Drug Programme (EDP) their first line of choice for the procurement of drugs in order to ensure quality and better value for money.
2	Council was of the opinion that since the routine inspection by the Department of Pharmaceutical Services of the State Ministry of Health was an on-going activity, the resuscitation of the task force on fake substandard and unwholesome substances would be superfluous; the strengthening of routine inspection was therefore strongly recommended.

IV. Quality of Service and Service Delivery

1	The Ministry of Health was requested to ensure the enforcement of standard of practice for all private laboratories, nursing/maternity homes, pharmacies/patent medicines stores and all private health establishments.
2	Council saw the urgent need for vigorous advocacy at individual and community levels to revive the utilization of Family Planning (FP) Services. To this end, Family Planning work environment should be made more attractive and friendly while Service Providers should be reoriented on work etiquette and client privacy.
3	It was resolved that Hospitals and all LGAs should incorporate cervical cancer screening into their health programmes
4	Council recommended that the State should immediately commence the implementation of Integrated Maternal, Newborn and Child Health (IMNCH) strategies, while determining the training needs at LGAs before implementation at that level.
5	The best practices in injection safety as introduced by John Snow were acknowledged by Council and therefore should be sustained. To this end, incinerators were to be installed in all health facilities.
6	Council noted the continued relevance of Integrated Management of Child Illness (IMCI) and suggested its alignment with IMNCH for efficiency.
7	Council recommended that the Department of Medical Services of the State Ministry of Health should be adequately empowered to protect the health of the citizenry especially against quackery
8	Council noted that adequate recruitment and training of nurses/midwives and indeed all cadres of health workers is essential for effective health care. Council recommended expedited actions in this regard.
9	The importance of immunization as an efficient means of disease prevention and health promotion was deliberated by Council. It was recommended that relevant logistics and staff motivation should be accorded priority and that routine immunization should be strengthened.
10	It was further recommended that the referral system should be supported with improved expertise, communication equipment, transport and ambulance services.

V. Disease Surveillance and Health Management Information System

1	The SCH saw the need to establish Public Health Laboratories across the State to bolster disease surveillance and also the need for coordination of the activities of data gathering and disease surveillance with NHMIS to avoid unnecessary duplication.
2	It was resolved that Edo State should train the operators of private health facilities on the use of the National Health Management Information System (NHMIS) forms.
3	In the spirit of public-private-partnership (PPP), the SCH resolved that the State Ministry of Health should sustain and expand collaboration with Rotary International and other such partners beyond Polio Eradication.
4	The detection of wild polio in Edo State after nine years of good report was noted by Council with dismay. It therefore recommended that routine immunization, emergency preparedness and response should be strengthened in the State.

VI. Leadership and Governance

1	The need to raise health higher in the development agenda and improve budgetary allocations for health was noted. All tiers of government were requested to meet the WHO recommendation of allocating a minimum of 15% of Capital Budget to health in order to allow for health sector improvements.
2	The meeting recommended the establishment of a State Primary Health Care Development Agency by Edo State Government as a means of addressing the challenges of PHC in the State and sued for expedited passage for the relevant bill.
3	The increased wave of kidnapping of health staff and threats to life and property in the State were noted. Government was requested to urgently address the situation.
4	Council recognized the role of Traditional Medicine especially when it is based on evidence. The setting up of State Traditional Medicine Board as a way for continued monitoring of the practice was recommended.
5	The SCH further resolved that intersectoral issues impinging on health e.g. poverty reduction, energy and power supply, education, nutrition, water supply, security, general infrastructure and sundry utilities should receive greater attention.

VII. Finally

1	The contributions of all participants at the meeting were noted and commended. Council particularly thanked the State Governor for making the yearly meeting possible within his first year in office. The support of the ADB-assisted HSDP and other partners were gratefully acknowledged
2	Council resolved to hold at least one meeting annually and to closely monitor progress in the implementation of the resolutions and recommendations made at the current meeting.