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Sokoto State Free Medicare Programme For Pregnant Mothers And Children Under Fives (Fremcare)
Sokoto State lies in the North Western part of Nigeria between longitude 11’30 and 13’50 east and latitude 4 to 6’0 North, with a surface area of 26,648.48sq kilometers. It has an estimated total population of 3.6 million as per 2006 census. Women of child bearing age constitute about 20% while children under 15 years make up 40% of the total population. Women and children are therefore the major consumers of health care services. The state has 23 LGAS, 120 health Districts and 244 political wards.
Presently, there are 538 health facilities within the three tiers of health care delivery system. Among these are two tertiary health facilities owned by the Federal Government, namely the Usmanu Danfodiyo University Teaching Hospital (UDUTH), and the Federal Neuro-psychiatric center at Kware. The State Government has a Specialist Hospital Sokoto and 18 General Hospitals fairly distributed within the 23 LGAS. The remaining are PHC, Clinics and dispensaries run by the LGA Councils. There are obviously adequate institutions all over the state, but there is serious challenge relating to manpower and equipments. Free medical care as of now is restricted to leprosy, tuberculosis and HIV/AIDS. The most common causes of morbidity include Malaria, Diarrhea, Dysentery, Measles, Typhoid fever and Tuberculosis, with Malaria being the highest among the causes of children death. Women die mainly from complications during pregnancy and delivery due to Hemorrhage, Sepsis, Pregnancy associated high blood pressure, Anemia, Malaria and unsafe abortion resulting largely due to inadequate maternal healthcare.
Critical Challenges In Health Care Delivery
• Maternal mortality rate about 900/100,000, higher than the national average of 840/100,000 live births against 50-100/100,000.
• Infant mortality rate about 80/1000 by 28 days and 25/1000 for children under 5 years against 5-10/1000.
• Population largely resides in the rural areas, poor and uneducated.
• Inadequate health care infrastructure and skilled manpower.
• Inadequate health care equipments and logistics.
• Local traditions, beliefs and inhibitions.
Opportunities For Effective Healthcare Delivery
• Achieving the goal targets of MDGs, NEEDS and SEEDS of reducing poor health indices by 2/3 by 2015.
• Strong political, financial and moral commitment by the State government.
• Tremendous opportunities for partnerships and collaboration with stakeholders, donors and NGOs at local, national and international levels.
• Purposeful and effective disbursement and tracking of healthcare resource investments
The Free Medicare Programme (Fremcare)
The Aliyu Magatakarda’s Adminstration has since inception made effective healthcare delivery among its cardinal objectives and priority areas. The free medical care for children under five years and pregnant women was conceived with a view to drastically reduce morbidity and mortality for enhanced health status of the state populace as a means of achieving rapid socio-economic growth and sustained development of the state.
Programme Objectives And Targets
• Reducing the maternal mortality rate of 900/100,000 by 30% p.a
• Reducing mortality rate children under 5 years 25/1000 by 30% p.a
• Reducing infant mortality of 80/1000 by 28days by 30% p.a
• Reducing household medical expenditure by 40% p.a
• Improving health status of school age children by 40% p.
• Increase in availability and accessibility of essential obstetric skilled birth care by 20% p.a
• Increase in availability and accessibility of essential antenatal care services(4 doctor visit per pregnancy) by 20% p.a
Main Health Care Services Targetted
Children Care: - Prevention, treatment and control of Malaria, Diarrhea, Dysentery, Measles, Typhoid fever and Tuberculosis, etc.
Pregnant Women: - Clinical Antenatal, Postnatal, obstetric, gynae and Emergency care services. Pregnancy and delivery complications including Hemorrhage, Sepsis,Pregnancy associated high blood pressure, Anemia, Malaria and unsafe abortion.
Programme Implementation Strategies
Adminstrative Procedure
• Drugs are made available at designated Hospitals and PHCs on monthly basis to satisfy demand.
• Drugs are stored under suitable conditions cabinets with bin cards and ledgers.
• Medical officers’ issues free drug issue vouchers to targeted beneficiaries after prescription.
• Designated desk officers issue the drugs and make entries in bin cards and ledgers and file the voucher copy.
• Monthly data records on drugs utilization are rendered by PMOs/desk officers to the trustee committee for onwards delivery to the state coordinating committee.
• Regular supervision, monitoring and evaluation of programme performance by Zonal health offices and the state coordinating committee.
• Rewards and incentives to best performing PMOs/desk officers, trustee committee and zonal offices; disciplinary action for deliberate failures.
State Co-Ordinating Committee
The State coordinating committee is the backbone of the FREMCARE programme in the state. It is responsible for programme identification, formulation, planning, implementation, supervision, monitoring and evaluation in all parts of the state. It is responsible to the state government and directly accountable to the Executive Governor. It presides over the implementation of the programme in accordance with policy guidelines and directives of the state government. The committee, chaired by the Honorable Commissioner of Health includes representatives of ministries of Health, Women affairs, Local Govt. affairs, Information, Religious affairs, Sultanate Council, HSMB, WHO, UNICEF, UNFPA, UDUTH and NMA.
Role Of Local Government Areas
The total co–operation of the local governments in the implementation of FREMCARE is highly contingent. Being nearer to the grassroots than all tiers of governments and in consideration of the targeted beneficiaries of the programme, the role to be played by the local government councils must therefore be involved in running the programme in all its ramifications.
Role Of Hospitals / Phc Trustee Committees
The primary activities of the FREMCARE are directly exercised by the hospitals / PHCs trustees committees.
• The committee in each hospital and PHC is to monitoring day – to – day implementation and monitoring of FREMCARE services to pregnant women and children less than five years.
• The Trustees committee in each hospital liaises with the state standing committee through the Director Medical services and public health and Executive Director, Hospitals services management board. Each committee must submit comprehensive monthly report of activities to the state coordinating committee.
• The composition of the trustee committee includes medical personnels, LGA officials, traditional and religious leaders, politicians, women leaders, community based organizations, NGOs, development partners etc
• The Trustees committee undertakes public enlightenment and sensitization activities. Plays advisory role on strategies and modalities of operation, maintaining surveillance on the programmes implementation at the grassroots and making constructive criticism where necessary.
Collaboration, Partnership And Linkages.
The FREMCARE programme collaborates extensively and establish strategic partnership and linkages with all agencies and organizations that will enhance the accomplishment of the targeted objectives. Among them are the Federal ministry of Health(FMOH),National Primary health care development agency(NPHDA),WHO.UNICEF,UNFPA,UNDP, the World Bank, EU-PRIME,USAID,GHAIN, the Mass media etc.
Other Programmes in the series:
• Rural Mobile Healthcare Programme (RUMCARE)
• MDG/NHIS Maternal And Child Healthcare Insurance Project
• MDG Intervention Project On Malaria Control And Obsteteric Care
• Community Health Insurance Scheme in partnership with HMO
• State taskforce on Polio eradication and routine immunisation.
• Health systems developmet project iii-worldbank assisted
• State action committee on HIV/AIDS control –SOSACA
• Roll back Malaria program
• State Eye Care Program x- Leprosy/T.B. Control Program
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