Health Profile of Adamawa State
Adamawa state is situated in North Eastern Nigeria. It has a landmass of 36,917 square kilometres. The state has 21 Local Government Areas (LGAs) and a 2016 projected population of approximately 4.1 million people. Yola is the administrative headquarters. The state has 1,032 primary health clinics, 17 secondary care centres, 2 tertiary hospitals and a handful private health facilities. In 2014, the Health indicators were as follows: Infant mortality rate (IMR) of was 115/1000 live births, under fives mortality rate (U5MR) of 185/1000 live births, and maternal mortality rate (MMR) of 1,100/100,000 live births. The Doctor to Patient Ratio was 1:375,000, while Nurse to Patient Ratio was 1:54,230.
The health policy and infrastructure
The health policy in Adamawa State is strictly based on the Nigerian National Health Policy, put in place since 1986 and revised in 2014, which is based on the concept and practice of Primary Health Care (PHC). Periodic review of the policy was done with little modifications through the National Primary Health Care Development Agency (NPHCDA). Currently, the State is piloting Performance Based Financing (PBF) approach to health financing for the Government of Nigeria through the World Bank Assisted Nigeria States Health Investment Project (NSHIP) that became effective in August 2013. Concurrently, The European Union is supporting the scale up of Maternal, Newborn and Child Health (MNCH) interventions with Fifteen Million Euros grant through UNICEF.
The Adamawa State Primary Health Care
Adamawa State established by law, The State Primary Health Care Development Agency (SPHCDA) in 2011 and achieved PHC Under One Roof (PHCUOR) in 2012. The Agency has accomplished the attainment of the “3 Ones” of One System, One Plan and One Management. A comprehensive PHC framework is developed in 2014 as a roadmap to PHC implementation by the Agency with the support of partners and all stakeholders including the benefitting community members. The system has 403 health teams that manage Minimum Ward Health Care Packages (MWHCP) to be accessed by the entire State population through their unit plans contributions, which are contractually agreed and reviewed regularly with the SPHCDA. The 226 Ward Development Committees (WDCs) at the ward level and the PHC Authority supervision and monitoring team at the Local Government Authority (LGA) level support the health teams. The State technical team also provide direct support to the LGA, WDCs and the health teams.
Adamawa State has sixteen (16) general hospitals and a Specialist Hospital, providing secondary care. The State Primary Health Care Development Agency went into contract agreement with the seventeen hospitals to provide Complimentary Package of Activities (CPAs) – mainly referral services from the minimum packages but also with measurable outputs and targets. The individual hospital committees manage the contracts with the support from the State’s Hospital Services Management Board.
The Boko Haram Insurgency
Seven (7) Local Government Areas (LGAs) were completely invaded in October 2014 and occupied for several months by the Boko Haram insurgents leading to massive killings and destructions. Reclamation of the LGAs by the Government of Nigeria still left many homeless as internally displaced persons (IDPs).
Internally Displaced Persons
More than a million persons were displaced from the seven (7) northern Adamawa State LGAs in October 2014. The government set up designate IDP camps in Yola South and Girei LGAs that even at the peak of the crisis, could cater for less than 50,000 people at a time. many IDPs resorted to take refuge in open spaces within their host communities or with relatives if they are lucky to have otherwise create new settlements entirely to try and survive. The mosques and churches also harboured a sizeable number of the IDPs and catered for them.
The Nigeria’s National Emergency Management Agency (NEMA) in collaboration with International Organization on Migration (IOM) have released series of Data Tracking Matrix (DTM) reports depicting the effects of Boko Haram on the affected population. The map below clearly shows that Madagali, Michika, Mubi North and Mubi South LGAs were completely deserted under the occupation of Boko Haram. All the other 17 LGAs have recorded a significant number of internally displaced persons.
By June 2015, the pressure by the self-returnees have reached climax that even Michika LGA became populated, despite devastation left behind by the Boko Haram insurgents. Many are still homeless, jobless and hopeless but yet prefer to be “home” than face the conditions of the IDP Camps as shown in the map below:
President Buhari promised the end of the insurgency by December 2015, which gave the people more hope and assurances that the Government is with the people. By February 2016, Madagali LGA is safely repopulated, as shown on the map below, but highly challenged by the hit-and-run pockets of insurgents and very slow humanitarian response.