Cablegate: Nigeria: Basics Ii Contribution to Child

This record is a partial extract of the original cable. The full text of the original cable is not available.

291410Z Dec 04




E.O. 12958: N/A

REF: ABUJA 001770


1. Basic Support for Institutionalizing Child
Survival (BASICS), both I and II, has been the flagship
child survival program of USAID/Nigeria since 1993,
addressing the issues of immunization, nutrition and
malaria. BASICS I ended in 1999 and BASICS II became
operational in 2000 in three states (Abia, Kano and
Lagos) and a total of 20 local government areas (LGAs)
within those states.
2. BASICS II was responsible for reporting on three
child survival performance indicators in its target
areas: Exclusive Breastfeeding (EBF) Practice; DPT3
Coverage; and Maintenance of Standard Registers in
Primary Health Care facilities in their target
communities. In all three categories, performance in
the 20 Local Government Areas where BASICS II worked
greatly exceeded the national averages, as reported in
the 2003 National Demographic and Health Survey (NDHS)
and, in all but one category, exceeded its own set
targets for the life of the project.
3. The community based and led approach employed by
BASICS II in its target states has been widely adopted
at both federal and state levels. END SUMMARY
4. The BASICS II Program which ended in September
2004 began officially in Nigeria in the year 2000,
following a long transition from the BASICS I Program
and its work with the private sector and NGOs. Because
of the new democratic regime in Nigeria, which began
with the inauguration of President Obasanjo in May
1999, USAID was again able to engage with the
Government of Nigeria. BASICS II introduced a new
approach called CAPA (Catchment Area Planning and
Action), a community based and led platform for
addressing child health service delivery, but flexible
enough to accommodate any issue that a community wished
to address on its own. In this context, a `catchment
area' is defined as the geographical area that is
served by a primary health care facility.
5. The technical focus areas addressed by the BASICS
II Project were: immunization, both routine and
supplemental (polio eradication primarily); nutrition;
and malaria, and the geographic reach of the Project
was a total of 20 local government areas (LGAs) in
three states of the federation, Abia, Kano and Lagos,
with a total population of 7 million people, and a
target population (children under five years of age) of
1.4 million. The current total population of Nigeria
is estimated to be 130 million people, with
approximately 40 million of them being under five years
of age. USAID, through BASICS II, played a major role
in the polio eradication initiative (PEI), being the
only agency to undertake responsibility for training of
the PEI personnel at all levels.

6. The 2003 NDHS reports a mean EBF rate for infants
up to 6 months of age of 17.2% nationwide
(disaggregated data by state not available). By
contrast, BASICS II achieved 29% (Abia), 34% (Kano) and
36% (Lagos) EBF coverage, as reported in their 2003
Integrated Child Health Cluster Survey (ICHCS).
7. For full immunization coverage, the 2003 NDHS
reports 13% nationwide (again, disaggregated data not
available). BASICS II reported, in its 2003 ICHCS
Survey, coverages of 31% (Abia), 28% (Kano) and 31%
(Lagos) for DPT3, the proxy used for full immunization
coverage. BASICS II further reported that its coverage
figures would have been considerably higher (i.e.,
demand was high), but routine antigens were
consistently unavailable from the national level,
causing stock outs in the primary health care (PHC)
8. There was no reporting of Maintenance of Standard
Register (of basic health interventions for children
under five in PHC facilities) in the 2003 NDHS, but
BASICS II conducted a baseline survey on all its
indicators at the beginning of the project. Baseline
for this indicator was zero (0) for all three of their
states and all 20 of the target LGAs. The importance
of this register is seriously undervalued nationally,
accounting for the fact that minimal data are available
in Nigeria on health indicators. By working with both
the national and state levels of the Government of
Nigeria, BASICS II was able to supply its target PHC
facilities with registers and provide training in their
use. By project end, the 2003 ICHCS reported 93%
(Abia), 41% (Kano) and 96% (Lagos) of facilities
regularly using and maintaining standard registers.


9. Arguably, the most challenging state in Nigeria in
which to work on health issues is Kano State, even as
it is the most needful of the services (health
indicators are consistently the worst in the northwest
of the country and particularly in Kano State). The
BASICS Program (both I and II) has been a fixture in
Kano State since 1994. Because of BASICS indigenous
staff and their understanding of the environment, as
well as the positive working relations they have
established, both at community level and with the state
and local government entities, BASICS II was an
accepted and important part of the Kano health delivery
system. During the year long moratorium of oral polio
vaccination (OPV) activity in Kano State, BASICS II
remained in place, continuing its work on routine
immunization (and all other child health issues) and
taking a low key, but very effective, part in the
advocacy necessary to resume OPV administration in the
state. At one point during the height of the
controversy, USAID was the only agency invited by the
Kano State Government to remain working in the state.
Kano rejoined the PEI effort fully in September 2004.
10. It was also in Kano State that BASICS II very
successfully initiated the Positive Deviance/Hearth
Model for rehabilitation of malnourished children. The
comprehensive BASICS II approach in the challenging
state of Kano was so well received, effective and
doable that the Kano State Government has adopted CAPA,
renamed it PLACO (Participatory Learning and Action for
Community Ownership) and is providing the resources,
both human and financial, to scale up statewide (44
LGAs). The Kano State Governor, the Kano State
Commissioner for Health and the Kano State Primary
Health Care Director have each requested that USAID
continue, to the extent possible and feasible, to
provide technical assistance and support for their
PLACO initiative. They are also insisting that all
immunization, routine and supplemental, be carried out
in Kano State through the PLACO mechanism.
11. USAID/Nigeria also introduced, into its three
target states, the concept of twice yearly Child Health
Weeks as a delivery mechanism for a package of child
health services, including routine immunization,
vitamin A distribution, deworming, retreatment of
insecticide treated bednets, etc. Because of the
success of this concept in the BASICS II states, the
Federal Government of Nigeria (GON) has taken the
decision to adopt this program for use nationwide,
making vitamin A distribution the centerpiece activity.
The GON also believes that this activity will
significantly boost routine immunization coverage and
serve to make immunization campaigns more acceptable in
certain areas.
12. Nigeria has fully joined in the effort to meet the
Millennium Development Goals (MDGs) by 2015. Goal no.
4, to reduce child mortality, goal no. 5, to improve
maternal health and goal no. 6, to combat HIV/AIDS,
malaria and other diseases will be, in large measure,
reached through child survival interventions. Child
mortality will be reduced most dramatically through
interventions such as routine immunization, improved
nutrition (including EBF, appropriate complementary
feeding of infants and young children and appropriate
distribution of vitamin A and other supplements) and
concentrated efforts toward the diagnosis and proper
treatment of malaria and diarrheal disease. Improved
maternal health must also begin with improved
nutrition, beginning long before pregnancy and
continuing throughout the life cycle. Although
HIV/AIDS is, at least in the short term, a stand-alone
initiative, the goal of combating malaria and other
diseases is part of the child survival mix through
support to routine and supplemental immunization
programs, promotion of malaria prevention methods and
appropriate treatment for all childhood illnesses.
There is a strong case to be made for the fact that
nutrition is an integral part of all eight of the MDGs,
and nutrition is carried out in USAID/Nigeria through
child survival funding. In order to achieve these
laudable goals in Nigeria by 2015, significant
increases in child survival funding well above the
levels now provided will be necessary from all donors
and from the GON.
13. Child survival remains, and will forever remain, a
development staple. USAID has established a strong
comparative advantage and leadership for child survival
programming in Nigeria. We continue to join with other
donor agencies, government officials, NGOs and
communities to improve the health status of children
under five years of age and beyond, including the
health and wellbeing of their mothers.
14. USAID/Nigeria, through its new implementing
partner, COMPASS, will work in five states (Lagos,
Kano, Bauchi, Nassarawa and the Federal Capital
Territory) and a total of 50 LGAs within those five
states. This expansion will greatly increase our
potential reach and impact, but only with sufficient
accompanying resources. Further, much of the necessary
work will continue to take place at the federal levels
(e.g., policy and advocacy work) and adequate funding
must be provided to advance these efforts as well.


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