Public Health Development Programme
Health care process as a discipline is concentrated on the provision of assistance to individuals, families and communities in order to obtain, recover and maintain optimal health status and normal body functioning. Contemporary definitions of medical profession as a science and art, which is concentrated on quality life as understood by people and families. Thus, health care process is not solely focused on health recovery and care but also with the provision of quality living as well. Health care is the process of caring for, or nurturing, for an individual known as the patient. However, because of the some external factors, the government of some countries is not been able to support their people and provide their needs for optimum health.
The world is facing problems in terms of sustaining optimum health among individuals especially those who are in the Third World Countries or the developing countries. These countries are having problems in terms of sustaining the health of their people as well as the education because of the lack of financial resources. With this, they are in need of international organisations that would provide them assistance and since the United States are always willing to give assistance to other countries; one of the countries they have helped is Nigeria through their Community Participation for Action in the Social Sector Project (COMPASS). Primarily, the main goal of this paper is to analyse COMPASS to identify whether this has meet its aims and objectives. This paper will also discuss some of the strengths and weaknesses of the said programme.
Community Participation for Action in the Social Sector Project (COMPASS) is considered as one of the largest integrated health and education programme in Africa. It is said that Nigeria is the most populous nation in Africa, and more than two-thirds of its overall population lives on less than a day. As a response to the economic and population pressures, the people’s access to quality healthcare services and education are declining (Compass, 2008).
With the help of the United States Agency for International Development, the Federal Government of Nigeria has launched COMPASS in 2004. The five-year project will run until 2009. Aside from the USAID, there are also other partners which helps in initiating this health and educational programme, this include the Pathfinder International which has been initiating interventions to expand access of Nigerian people to quality healthcare and education services.
This health development programme is funded by United States Agency for International Development (USAID). The main goal of this programme is to reach approximately 23 million people in Nigeria in 51 Local Government Areas through the community led health and education programmes in five regions with polio-eradication activities in an additional six regions. The foundation of COMPASS composed of sustainable development programs in term of reproductive health/family planning, basic education and survival. This project operates under the tenet that attaining long-term success largely depends upon giving Nigerians the opportunity to own the programs and initiatives which directly influence their health and well-being.
Working in five states such as Kano, Lagos, Bauchi, Nasarawa and the Federal Capital Territory, this health development programme is committed to involving local communities of the country in establishing high quality, integrated education and health services. Giving emphasis on reproductive health, basic education and child health, COMPASS has been able to combine the work of three former USAID-funded health development and educational projects which include BASICS II, VISION and LEAP. Furthermore, COMPASS also coordinates with other two USAID projects which is the GHAIN and ENHANSE. GHAIN is a project which focuses on HIV/AIDS and tuberculosis and ENHANSE focus on health and education concerns through advocacy and policy.
Aside from its work in education and health, COMPASS also supports polio eradication efforts in the five states and other regions in Nigeria such as Kaduna, Kebbi, Jigawa, Katsina, Zamfara and Sokoto. This health development project’s approach is state specific and works with Local Government Areas to give the supplies and services necessary for the delivery of quality health care and education in communities. The following table presents the target of the COMPASS in various states.
Table 1
Lagos
Kano
Bauchi
FCT
Nasarawa
Total
Number of Target LGAs
14
16
6
8
7
51
Population of Project LGAs
10,700,000
3,600,000
500,000
2,200,000
1,000,000
18,000,000
% of state population in target LGAs
86
43
100
57
59
66
Source: Compass Nigeria, 2008. Online available at http://www.compassnigeria.org/site/PageServer?pagename=Where_We_Work. Retrieve April 22, 2008.
In year 2008, COMPASS expects to reach 23 million individuals across 51 Local Government Areas in the five project states, as shown above. In addition, COMPASS is also expecting to reach an additional 5 million people via the national level interventions.
The support of this program which can be drawn from policy is in line with the decentralized approach and results-oriented policies, specifically in the implementation of the project which permits close collaboration with local and state government authorities in both health and education sectors.
In addition, the support can also be drawn from the policy of the local and federal government of Nigeria of providing quality healthcare services and educational services among their people. To be able to keep with the decentralized approach, this health development programme has established offices in the five states included in the programme. Herein, in order to ensure that the project will directly help Nigerians, COMPASS adheres to the policy of providing ownership of the project through the representatives from each States. The State Teams are directly accountable for project implementation, with guidance and support from a central coordinating office in Abuja. To ensure that the objective of COMPASS is achieved, the States Team considered field officers are stationed within Local Government Areas (LGAs) which is the Nigerian equivalent of districts. Their role is to facilitate and monitor the COMPASS activities at the community level. It can be said that the support of the project also came from the community policy of each of the state included in the project.
As mentioned above, it is said that this five year project has integrated the expertise of American partners as well as Nigerian partners to involve local communities in establishing high quality integrated health and education service to less fortunate people. Recognizing the value of supportive government policies in implementing successful healthcare development programs, COMPASS has been able to finalize and field tested the Policy Environment Score instruments for its three core areas: Basic Education, Child Survival and Reproductive Health. PES has been used to evaluate changes in the policy environment and assists to identify sectors in need of high quality health and educational services. The instrument used for the Reproductive Health was adapted from the current Policy Environment Score which has been development by the former Policy Project. On one hand, the Basic Education as well as the Child Survival instruments was newly formalized. With these policy instruments, the local government is able to measure and evaluate the entire status of the policy environment in their states and assess changes over a specific period. The instruments will be used in the five COMPASS supported regions and the outcome will guide in determining priorities and setting agendas to enhance policy environments.
Recognizing the needs of Nigeria in terms of a programme that would enhance their health condition and educational status, Nigerian Government, along with the USAID and other 9 partners have been able to initiate a five-year project (COMPASS) for Nigerians. It can be said that this five-year project has some strengths and limitations.
One of the strengths of this health development programme is in line with its support systems and partners. It is said that the project encompasses 51 LGAs which represents 66% of its total population in 5 states (Lagos, Kano, Federal Capital Territory, Bauchi, and Nasarawa), thee areas differ widely in terms of density and population which reflects the disparity in terms of health, wealth and education.
The help of nine the partners of USAID and Federal Government of Nigeria can be considered as one of the strengths of the project since these partners are able to provide assistance to achieve the goal of the programme. For instance Pathfinder International and MSH (MSH, 2008) works as a partner for COMPASS on one of the eight sectors of the project, i.e. child survival, which includes the polio eradication in six additional states mentioned above.
Furthermore, other strengths of the COMPASS project is attributed to the people who are involved in the project. It can be said that before the implementation of this project, member, partners and project leaders are able to collaborate well to train and develop the skills of the people who will be involved in the said project. In addition, they also provided workshops and trainings for the field people who will be representing each state involve in the said project. It can also be said that one of the strengths of COMPASS is their ability to divide their responsibilities to ensure that the objectives and goals are being achieved and met.
In this regard, the Adolescent Health Information Project is the partner responsible for providing guidance on implementation of the Adolescent Sexuality and Reproductive Health (ASRH) education provisions and policies. On one hand, the Civil Society Action Coalition Education For All (CSACEFA) is responsible for coordinating with civil society organisations to initiate education activities and accountable for establishing the capacity of local organisations and Community Coalitions to support for and implement coordinated health education programs. Another Partner of COMPASS is the Creative Associates International Inc which is responsible for the technical assistance in school health, basic education, mobilization of PTAs and the national union of teachers.
The Federation of Muslim Women’s Association of Nigeria is a partner responsible to lead as well as promote programs for social sectors services, specifically women and girl’s education, child survival, safe motherhood and strengthened education as well as health programs among the selected schools. The Johns Hopkins Univesity Center for Communication Programs is the one responsible for community mobilisation, communications for community support, partnership-defined quality and demand creation activities. The management Sciences for Health is the one responsible for immunisation, child health, institutional capacity building, malaria and most especially strengthening community-based institution. The Nigerian Medical Association is accountable for spearhead capacity-building approaches for healthcare providers, review, institutionalise, update and monitor standard if practice in curriculum for pre and in service training, NMA is also responsible for public-private partnerships as well performance improvement interferences. Pathfinder International is responsible for overall operations of the programme specifically in terms of financial, logistical and technical management as well as coordination of project activities, grants management, promoting public-private relationships, reproductive health interferences and workplace-based health programs and last the Futures Group International is the one responsible for monitoring and evaluating the project, generating reliable data, policy and advocacy at each state and LGA departments and link with policy work at the national level. It can be said that each of this partners are able to do their jobs and responsibilities to ensure that they provide quality health care services and educational programs among Nigerians. Aside from these, it can also be concluded that the strengths of the COMPASS includes its high potentials for health care development and growth as well as the policy and provision initiatives of the Nigerian government. These strengths can be attributed to success of this program.
With the successful planning and implementation of COMPASS in Nigeria, it can be said that this program has only minimal drawbacks of weaknesses. One of these weaknesses is in terms of the financial resources which might be insufficient for the last two years of the initiation of the program. Since the program is a five year project, the partners, USAID and the Nigerian Government may not be able to sustain its financial resources which may affect the overall provision of the said project. Another limitation will be the lack of support of other LGAs, local community and individuals within Nigeria. It is said that a successful project needs people who are supportive to ensure that cooperation and coordination is always met.
All in all, it can be noted that implementation of COMPASS is on its way to getting its aims and objectives which is to enhance health conditions of the five states and provide educational services in Nigeria to lessen illiteracy among people.
In order to ensure that the USAID and Nigerian government will be able to achieve the objective of the healthcare and educational project, the following recommendation may be applied. First, the project managers must be able to ensure that all operations and activities adhere to their goals and objectives. It can be said that the health development program are accomplished by applying resources to functional requirements. Resources, in the context of project management, are generally made up of people and equipment, which are typically in short supply. The people needed for a particular task may be committed to other ongoing projects. In doing so, the leader and authorities of the COMPASS project should also be able to consider resource allocation, to ensure that their budgets will be sustained. In this regard, ranking of activities for resource allocation may be done under parallel priority or serial priority. In serial priority, the relative ranking of all activities is done at the beginning prior to starting the scheduling process (Badiru, 1993). The activities maintain their relative priority ranking throughout the scheduling process. In the parallel priority approach, relative ranking is done at each scheduling instant and it is done only for the activities that are eligible for scheduling at that instant. Thus, under the parallel priority approach, the relative ranking of an activity may change at any time, depending on which activities it is competing with for resources at that time.
For this COMPASS Nigeria Project, the resources of the company include team organisation (USAID, Nigerian government, and 9 partners) and scheduling/time management. Consequently, the project will not be able to meet its objective if the tasks are not allocated to the respective people in the team in designing and initiating the COMPASS project and sustaining its functions and operations. For this project, roles should be assigned carefully and benevolently and to individual group members in order to avoid miscommunication and misunderstanding. In initiating the COMPASS project, specifically in its last two years of implementation, the people involved must be able to sustain their capabilities to finish the project
Time is sometimes one of the problems since there are plans in the COMPASS programme that are demanding for unrealistic time. For this project, realistic schedule viewed by the team should be imposed. Outside world are not allowed to deflect team form what knows to be practical. If the impose a deadline upon which is impossible, the team will clearly state this and give reasons. It is critical to develop and keep to a realistic schedule for the COMPASS project. In developing the schedule for building the education centre and healthcare centres the team should keep in mind the use of a systematic design approach with phased activities; develop a project profile to understand better what staff, tools, and techniques are needed.
The success of the COMPASS project depends on the people who will handle the project from the first phase to the last stage of the initiation of the COMPASS in Nigeria. It can be noted that, in handling a project, specifically, health development project or programme, there are two general issues that might be considered. These issues include the technical and the non-technical complexities. With these issues, the project manager must have the ability to provide specific solutions for these two differing problems. Having been able to determine the solution for technical problems, not necessarily means that the project manager will use this to solve issues for the non-technical problems. Non-technical problems may include the soft human issues that the project manager may encounter. The project manager must bear in mind that management means getting things done through the active support of other people.
The manager has a core responsibility to manage people who will be involved in the stages of the five-year program,, (COMPASS( in order to come up with an efficient healthcare project in Nigeria. Further, the manager has role of maintaining effectiveness and efficiency. If the manager does not give consideration to these aspects, potential soft human issues may arise.
One of the potential soft human issues that might be encountered is in terms of cultural diversity and differences among employees and staff who will be involved in the healthcare development programme. Diversity and differences may lead to internal conflict if the project manager would not give consideration to this factor (DeLuca & McDowell, 1992). For managers leading or working in diverse staff, the level of flexibility, communication capabilities and hands-on management needed often goes above and beyond what they are accustomed to. Regardless of where they are located, managers may find themselves challenge to motivate struggling employees. Managing culturally diverse project team members also result in another internal soft human issue which is in terms of having poor communications (Chambers, 2001). It is important that the members of the COMPASS should have knowledge in different types of communication in order to determine which of these forms will be useful in assuring that poor communication will not become a hindrance to successful implementation of the Project.
Conclusion
Indeed, initiating or implementing a healthcare development programme a country like Nigeria is a difficult task, however, it can be considered as the strongest and powerful tools that can be used for securing the health and educational status of the people in the country. It can be concluded that the COMPASS project, being in its last two years are able to achieve their goal of enhancing the health conditions of people in Nigeria as well as their educational status. Being able to have assistance from both national and international institutions are key for the success of its implementation and the collaboration of these partners has served as the building block of the project.
Reference
Badiru, A.B. (1993). Quantitative Models for Project Planning, Scheduling, and Control. Quorum Books: New York.
Baumgartner, J. S. (1979). Systems Management. The Bureau of National Affairs, Inc: Washington, D.C.
Chambers, H.E. (2001). Effective Communication Skills for Scientific and Technical Professionals. Perseus Books: Cambridge, MA.
Compass Nigeria (2008). Online available at www.compassnigeria.or. Retrieve April 22, 2008.
Compass Nigeria, 2008. Online available at http://www.compassnigeria.org/site/PageServer?pagename=Where_We_Work. Retrieve April 22, 2008.
MSH (2008). Online available at http://www.msh.org/programs/nigeria_compass.html. Retrieve April 22, 2008
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