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MAILAFIYA
FEDERAL CAPITAL TERRITORY ADMINISTRATION, ABUJA NIGERIA
Nigeria

The Problem

The Mobile Primary Health Care Programme ‘mailafiya’ in partnership with Intel Corporation is an innovative approach to address the challenge of shifting care beyond the traditional institutional setting to where ICT is helping to increase access and quality and reduce the costs of care. How technology could be used to bring health care to people in great need in remote areas.
By 2007 there abound data from Cross Sectional Country Surveys and Studies by Development Partners (e.g. National Health and Reproductive Country Survey, 2005) in the Health Sector demonstrating poor health indices in the country.
There was the general perception that the Millennium Development Goals 4, 5 and 6 targets will not be met by 2015
Within the Federal Capital Territory (FCT), 2008 multi-variable community baseline survey demonstrated that:
60% of residents of over 800 communities belonged to the lowest poor
336 Communities out of 858 identified do not have access to health care services
WHO estimated that, in FCT
adequately serving the population
would require 434 Primary Health
Centers (PHCs), but only 179 existed,
many of which were operating at
sub-optimal levels or located long
distances from rural populations
Abound in the communities were unorthodox healthcare practices;
To embark on a large expansion of the number of traditional PHC facilities was clearly cost prohibitive. Effectively meeting MDGs and treating chronic illnesses would require a very different approach, it was clear that ICT could play a major role if it could be effectively implemented to deliver a more cohesive continuum of care.
The FCT was committed to pursuing improvements in Millennium Development Goals 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria, and other diseases).
In early 2009, the Nigerian Federal Capital Territory Millennium Development Goals Unit (FCTMDGU), health officials, traditional institutions and Intel Corporation began discussing ways that mobile health and Information and Communication Technology (ICT) could be used to improve health and healthcare delivery in rural areas.


Mailafiya, an integrated data managed mobile Primary Health Care programme, serves the following purposes:

•Delivering health care to the unreached rural and indigent poor population in the FCT.
•Improves quality of Primary health care services,
•Increases access to quality Primary health care services
•enhances health system evaluation and planning,
•controls loss of medical inventory and
•Fast tracking attainment of the MDGs 4, 5 and 6 targets.
The programme is achieving all these through sensitization, Technical training and process automation.

Solution and Key Benefits

 What is the initiative about? (the solution)
ACHIEVEMENTS
There has been Increasing access, improving response rate to disease outbreak in the communities and the quality of healthcare service delivery

The programme is providing platforms for health systems research particularly community based studies in the FCT

The programme has Created dependable data base for tracer diseases and other morbid human situations in communities in the FCT. Details could be found at the mailafiya website - www.fctmdgmailafiya.org and www.ehealthfct.net

Reducing the cost of providing healthcare services delivery
•Provision of a connected health platform where all public and private health facilities can interface

•Successfully hosted the PAN African Health Summit on Mobile and e-health in Abuja Nigeria

•Was given the “Best Rural Health Practice” by the Federal Ministry of Health Nigeria

•Intel Corporation Worldwide has also recognized the “mailafiya” programme in the “World Ahead Recognition Award”

•The programme has been recognized as a good practices during the World Congress on Information Technology 2010 in the Netherlands

The programme was admitted for presentation at the International Conference on ICT for health in South Africa September, 2012

Since inception, the programme has seen and treated Seventy-five Thousand cases of tropical diseases

The impact assessment of the programme since three years of its inception based on house hold survey has been concluded. The preliminary report revealed that, there has been increased access to health care from 17% to 71% in all the communities of the Federal Capital Territory
The scope of the impact was to:
To identify the number of communities visited by mailafiya
To assess the quality of mailafiya service delivery

To determine the level of impact of the programme to the communities using appropriate indicators ( Goal 4,5 &6 outcome indicators)
To identify any challenges faced by the programme

To prepare, present and submit reports on findings and recommend how best to move the programme further

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The Mailafiya strategy was conceptualised following the FCT base line survey that revealed poor health indices.
Those who contributed to this project include
1. THe Honorable Minister of the Federal Capiatal Territory, Abuja - Senator Bala Muhammed
2. ARI Isa Muhammad- Director Economic Planining FCT
3. Dr Ndaeyo Iwot -Director,HPRS, FCT Primary Health Care Board
4 Dr Ibrahim Abubakar- Programme Manager, Mailafiya
5. All the six area Council Heads of Health Department in the rural area
6. Mr David Ibwho- Executive officer- Intel Corporation
7. Mr Dennis Etuke- Dencosoft Director,
6 The traditional rulers and faith base organizations
7. The programme field volunteers which include the 24 Medical Doctors, 24 Nurse/Midwifes, 24 Laboratory Scientists, 24 CHEWs and project drivers
Governance:
Mailafiya programme is basically driven by the FCT MDG s Project Support Unit of the FCT Administration.
The programme is governed by the Project Implementation Committee:
1. Director of Economic Planning FCT – Chairman
2. Chairman of Kuje Area Council (Algon) -Member
3. Chairman of Abaji Area Council – Member
4. Chairman of Bwari Area Council – member
5. Chairman of AMAC – Member
6. Chairman Kwali Area council – member
7. Chairman Gwagwalada Area Council – member
8. Director of Treasury – Member
9. Director of Procurement- Member
10. Director of HPRS/ HHSS – Member
11. Executive Secretary FCT PHCBD- member
12. Rep. of FCT Water board – member
13. Rep. of FCT Area Council Service Secretariat
14. FCT MDGs Focal Person – Secretary’
The Programme Manager Mailafiya oversee the activities and the implementation of the programme. The manager reports directly to the FCT MDGs focal Person who in turns sends reports to the Chairman of the Project Implementation Committee. All approvals are given by the Chairman of the Project Implementation Committee.
Members of the mailafiya operational structure includes
1. 24 volunteer Medical Doctors
2. 24 Nurse/Midwife
3. 24 Laboratory Scientists
4. 13 CHEWs
5. 52 Community Volunteer Health Workers
6. 12 Drivers
The monitoring committee includes
HOD health – AMAC (member)
HOD health Bwari AC (member)
HOD health Kuje AC (member)
HOD health Kwali AC (member)
HOD health Abaji AC (member)
The Programme Manager Mailafiya
Rep. of the UATH
WHO representatives
Representatives for FCT PHCBD
Medical directors of the FCT Hospitals

The financial contributions were made by
1. The Federal Government of Nigeria through the office of the Senior Special Assistant to the president on MDGs

2. The Federal Capital Territory Administration through Counterpart support funds

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
In views of the poor health indices, the strategy of the Mobile Health Team “mailafiya” is to provide integrated PHC services to the rural lowest poor communities particularly those in remote and difficult to reach settlements, with the adoption of new technology (ICT) to improve on the very poor status of Primary Health Care Management data base.

.The Mobile Primary Health Care Programme ‘mailafiya’ in partnership with Intel Corporation is an innovative approach to address the challenge of shifting care beyond the traditional institutional setting to where ICT is helping to increase access and quality and reduce the costs of care. How technology could be used to bring health care to people in great need in remote areas.

Mailafiya, an integrated data managed mobile Primary Health Care programme, serves the following purposes:
•Delivering health care to the unreached rural and indigent poor population in the FCT.
•Improves quality of Primary health care services,
•Increases access to quality Primary health care services
•Enhances health system evaluation and planning,
•controls loss of medical inventory and
•Fast tracking attainment of the MDGs 4, 5 and 6 targets.
The programme is achieving all these through sensitization, Technical training and process automation.
The vision of mailafiya is to be a world class model of Primary Health Care delivery with an integrated data managed mobile health solution
The goal of the scheme is to accelerate the attainment of MDGs 4, 5 and 6 Targets in the FCT.
The objectives are:

•To improve the quality of Primary Health Care services
•To increase access to primary health care services by 50% in at least three hundred and thirty six (336) rural settlements and the un-reached urban poor in the Federal Capital Territory by the end of year 2011

The scope of the program is in two folds:
(i) To provide Integrated PHC services and reach the defined settlements with one or more of the following characteristics in order to deliver community and facility based PHC services in a scheduled and integrated manner:
•Difficult to reach settlements;
•Communities which are five (5) kilometers and more from the nearest PHC facility;
•Communities with poor health outreach coverage;
•Communities with no functional two ways referral systems and;
•Communities with low income (below 1USD/day); and
(ii) Deployment of PHC management information system.
Programme Structure
•The programme consists of 24 teams and each team consists of a Medical Officer, Nurse/Midwife, Laboratory Scientist, Community Health Extension Worker and the Project Driver. Each team worked in alternate week

Each team is equipped with one double cabin fully air-conditioned 4-wheel drive high suspension pick up van with customized back carriage; mobile laboratory unit, essential drugs and routine vaccines to render free medical services

STRATEGIC LINKAGES FOR QUALITY AND COMPLETENESS OF CARE
A. Linkage to Communities- voluntary health workers, traditional chiefs actively carrying out sensitisation/mobilisation of communities to available services
B. Linkage to the Existing (static) PHC Facilities- Half of the team members are Area Councils employees and clusters are linked to existing PHC Facilities with data transfer through the PHC MIS. HOD (Health)/PHC Coordinators monitor programme in respective Area Council.
C. Linkage to the Secondary Health Care system- 2-way referrals from mailafiya to general hospitals/continued Free ANC
D. Linkage to Tertiary Health Care Providers- Minor surgery/ophthalmologic interventions/research with the Teaching Hospital Gwagwalada
E. Linkage to Other Health Services Providers-Birth attendants, community based Private health providers are linked to mailafiya service delivery plan

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
In early 2009, the Nigerian Federal Capital Territory Millennium Development Goals Unit (FCTMDGU), health officials, traditional institutions and Intel Corporation began discussing ways that mobile health and Information and Communication Technology (ICT) could be used to improve health and healthcare delivery in rural areas.

•Phases one and two ICT Trainings by Intel Corporation FCT Office with facilitators from Ireland trained the volunteers on ICT
2.Sensitization Meeting with the Graded chiefs of the FCT led by the Chairman, FCT Traditional Council of Chiefs, His Royal Majesty, the Ona of Abaji.
3.One week decentralized training of 52 Voluntary Health Workers (representing the Clusters) on Primary Health Care and their roles and responsibilities in the Mobile Health Teams.
4.Five days training of 18 volunteers; 6 Medical Officers, 6 Staff Nurse/Midwives and, 6 Laboratory Scientists/Technicians on Primary Health Care Scheme with emphasis on community based PHC Services at the FCT MDGs PSU Office,
5. Decentralized Three days retraining of 124 existing PHC personnel from PHC facilities linked to the Clusters for Mobile Health teams’ activities on Primary Health Care Scheme and community based PHC services
Pre- Test for the One Month “Test Run” of the FCT Mobile Health Team “mailafiya” in four communities of the Federal Capiatal Territory
The pre-test for Mailafiya was carried out in the following communities:
1. Kabin-Mangoro in AMAC
2. Wumi in Glada AC
3. Kuseki in AMAC
4. Mamagi in Abaji AC
The pre-test was a resounding success with large turn out of patients seeking for medical care

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
1.Access to many settlements and Communities has been very difficult and in some cases required the services of boats.
2.Difficulties in recruiting Health Personnel with passion for community health practice

3.People from neighboring states at border communities take the privilege of mailafiya to have access to medical care.

4.Double presentation by people to obtain as many portions of free drugs in some cases.

5.Funding to meet up growing expectations for medical care for the poor.
The following ways were used to overcome some of the challenges
1. Government plan to open up rural roads
2. The mailafiya team has combine the use of hand cards and automated generated Identity Numbers to prevent double representation
3. The project has adopted the use of convertible netbooks that can take photographs
4. The Federal Government of Nigeria is considering replicating Mailafiya project to all the 36 states in the country there by improving funding and sustainability

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Both human and financial resources were used to implement this project.
Currently the project has 24 Medical Officers, 24 Nurse/Midwifes, 24 Laboratory Scientists, 24 Community Health Extension Workers and project drivers all as volunteers. Each volunteer is payed an allowance at the end of every month. The project has 24 teams and each team is headed by a medical officer
The Mailafiya project spent a total of 588,000 USD per year compared to the static Primary Health Care Clinic that spents 13 million USD per year.
The cost benefit per patient is put at 22.14 USD for Maialafiya and 923.43 USD for patient attending static Primary Health Care Clinic
A proposal for the Conditional Grant Scheme is sent to the office of the Senior Special Assistant to the President on MDGs. The proposal are then evaluated and the grant is released with 50% counterpart fund contributions from FCT Administration

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The Initiative is being funded by the Government of Nigeria through the Office of the Senior Special Assistant to the President on MDGs and the Counterpart support fund from the Federal Capital Territory Administration.

The Federal Ministry of Health is considering replicating the initiative in all the 36 states of Nigeria. This remark was made by the Honorable Minister of Health of Nigeria during the just concluded National Conference on ICT in Health where Mailafiya project was presented
Mailafiya clustering design has informed Government of static PHC structures locations in the 52 clusters.

At the moment 30 prototype PHC facilities are at various stages of completion and additional 22 will be concluded by the year 2012.

These will serve as static operational bases for the mailafiya teams in the clusters

As part of the sustainability plan, The FCT Administration has approved the commencement and pilot for Community Based Health Insurance Scheme in FCT communities that have been empowered through Community Empowerment Agricultural Initiative (CEAI). At present, 60 communities are on pilot for the CBHIS and had payed their premiums.
A proposal to deduct 1 to 3 % of the total health budget to be used as subsidy for CBHIS is been looked into.
Mailafiya programme has also been pilot 2 communities using it to provide services for CBHIS

Lessons Learned

 What are the impact of your initiative and the lessons learned?
Strong political will and support from the Government of Nigeria and the FCT Administration with continuos funding of the project

The Technical staff in the field who have passions for rural health Care Service delivery have made the project successful

The deployment of ICT to enhance data capture and management has made the initiative very easy to the operators and has enhance health planning and research opportunities
The team spirits and project management by the programme Manager also accounted for the success

The Technical Staff received oversea trainings in UK and with better pay package had motivated alot of technical staff to stay as volunteers.

In order to improve the quality of services delivery, FCT Administration has recently procured three (3) 4WD Ambulances to facilitate referrals and emergency services to secondary and tertiary care centers

Contact Information

Institution Name:   FEDERAL CAPITAL TERRITORY ADMINISTRATION, ABUJA NIGERIA
Institution Type:   Government Department  
Contact Person:   ABUBAKAR IBRAHIM
Title:   DR  
Telephone/ Fax:   +234-8086187669
Institution's / Project's Website:   www.fctmdgmailafiya.org
E-mail:   ohikwo52@gmail.com  
Address:   FCT MDGs Project Unit, Apo Legislative Quarters, Abuja
Postal Code:   90003
City:   ABUJA
State/Province:   Federal Capital Territory
Country:   Nigeria

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