TRAINING WORKSHOP

ON
ATTITUDINAL CHANGE: THE FRAMEWORK FOR EFFECTIVE SERVICE
DELIVERY

September 7th – 10th, 2015

Lokoja, Nigeria

Communiqué

Background

“Health is Wealth” is a popular adage that summarizes the value of good health. This is
true both at the individual level and the societal level – the community, state and nation.
According to WHO definition, “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity”. It therefore behoves on
any system of healthcare delivery to cater for the total being in order to achieve maximum
productivity.

Health indices of a nation can aptly show how prosperous or developed that nation is.
Maternal mortality ratio of a country, for example, can be used to assess how developed a
country is. The developed countries have the lowest mortality ratio while the least
developed {developing countries} have the highest mortality ratio. Same can be said for
prenatal, infant mortality, under-five mortality and the average life span of adults in a
given country.

So healthcare delivery in the simplest term, means, the provision of healthcare services to
the people. A nation healthcare delivery system has significant inputs from the patients,
healthcare professionals, infrastructure financiers and other partners. A synergy of all
these stakeholders is required to achieve the desired results.

The health indicators for Nigeria are not the best and at the least, it is vulnerable of 10%
of the global diseases. According to the National Strategy Health Development Plan
{NSHEP} 2010-2015, Nigeria has the highest number of HIV infected persons in the
African continent and the fourth highest TB burden in the world, while the non
communicable diseases are on the increase. Health indicators fare very poorly coupled
with inequalities in health outcomes between the rural and urban areas, poor delivery of
primary healthcare services for immunize-able diseases, increase in poverty, increase in
unemployment, increase in corruption, high rate of infant and maternal mortality, poor
access to healthcare services, poor health education and bad leadership to mention a few.
The bleak healthcare delivery system in Nigeria calls for a quick attention for which an
attitudinal change is the first step.

It is in this context that the Federal Ministry of Health in collaboration with the New Era
Global Resources Limited organized this Training Workshop on Attitudinal Change: The
Framework for Effective Service Delivery of the Health Sector to enable health workers
Training Workshop on Attitudinal Change: The Framework for Effective Service Delivery in the Health Sector 1
 and stakeholders change their negative attitude to work, restore the work ethics and
discipline to healthcare system and consequently restore public confidence to the Sector.

The extensive pool of policy makers, researchers and healthcare providers also affords
participants at this Workshop the opportunities for networking and forging of useful and
strategic partnerships. Upon return to your health institutions, participants will expectedly
be equipped to adapt evidence-based strategies for successful healthcare delivery system
that meets the expectations of the general public.

Objectives of the Workshop

The Objectives of the Workshop include:
To reflect on, and chart the course for improving the quality and effectiveness of
healthcare delivery system in the Nigerian Health Sector, in line with global best
practices.
 To provide image laundering programme to the health sector.
 To ensure an effective and efficient healthcare delivery services
 To ensure an effective delivery of primary healthcare services for immunize- able
diseases.
 To restore cultural values and identity within the public healthcare services.
 To change the negative image of the public health and consequently restore work
ethics and discipline.
 To restore self confidence among and inculcate the spirit of patriotism among public
health services providers.
 To reduce inequalities in healthcare services between the rural and urban areas.
 To create public awareness that will reduce the high rate of infant and child mortality.

Participants

The Workshop was attended by 55 participants drawn from the Health Sector.

Highlights of Presentation

The Workshop was declared open by His Excellency, the Executive Governor of Kogi
State, Capt. Idris Wada (rtd.) who was represented by the Honourable Commissioner of
Health, Dr. Idris Omede, who, in his remarks, noted that there was no better driver of the
affairs of Nigeria than the healthcare providers who constituted the participants at the
Workshop. He observed that the Workshop was a significant step to charting a new ethical
and professional approach to healthcare delivery in Nigeria. He expressed the readiness of
the State Government to study and implement the recommendations from the Workshop.

Earlier, in his welcome address, the Medical Director, Federal Medical Centre, Lokoja,
Dr. D. G. Eleshin expressed delight that Lokoja was chosen as the venue for the
Workshop. He assured the participants that Kogi State is peaceful and has tourist sites that
would be of interest to them. The Director of Reform Coordination, Federal Ministry of
Health, represented by the Deputy Director, Reform Coordination, Mr. S. A. Balogun,
equally welcomed the Kogi State Government officials and the participants to the
Workshop.

Training Workshop on Attitudinal Change: The Framework for Effective Service Delivery in the Health Sector 2
 Barrister Helen Iyoha who represented the Permanent Secretary, Federal Ministry of
Health, Mr. Linus Awute, mni, in the keynote address described the Workshop as a
platform for sharing experiences and exchange of ideas by the stakeholders who are the
main drivers of the service delivery initiatives in the Health Sector. She enumerated some
of the challenges in Nigeria’s Health Sector and expressed hope that the Workshop would
proffer practical solutions that would launch the Sector to the next level.

In her vote of thanks, the Managing Director/Chief Executive Officer of the New Era
Global Resources Limited, Mr. Victor Onukogu, expressed gratitude to His Excellency,
the Executive Governor of Kogi State, Capt. Idris Wada {rtd.} represented by the
Honourable Commissioner for Education, Dr. Idris Omede for honouring the invitation
and for declaring the Workshop open. The thanked other State Government officials who
attended the opening ceremony. He thanked the Permanent Secretary of the FMH for the
unflinching support to the Workshop. He commended the Director Reform Coordination
and Service Improvement for his commitment to the Workshop. Mr. Onukogu thanked the
Resource persons and the participants for their presence. He wished participants fruitful
deliberations.

Communiqué
The participants of the 2015 Workshop on “Attitudinal Change: The Framework for
Effective Service Delivery of the Health Sector” held in Saatof Hotel, Lokoja, from 7 th
to 10th September, 2015 had a total of seven paper presentations and two syndicate
sessions.

Participants note:
 Dissatisfaction of patients and the general public in the quality of healthcare service
delivery especially in public health institutions;
 The inadequate funding of the healthcare institutions at all levels;
 Misuse of available funds for the healthcare delivery services;
 Inadequate number and inequitable distribution of healthcare professionals;
 Low capacity building of available healthcare professionals;
 Unethical and unprofessional attitude of healthcare workers;
 Unhealthy inter-professional rivalries in the Health Sector;
 The incessant strike actions by the unions in the Health Sector;
 The non implementation of circulars by relevant government authorities;
 The dilapidated/inadequate/lack of infrastructural facilities in the health institutions
across the country;
 Poor maintenance of healthcare facilities;
 Lack of effective and efficient monitoring of the healthcare delivery guidelines by
relevant bodies;
 Poor complaints handling mechanisms in healthcare centres;
 Inadequate public enlightenment and advocacy on health issues mostly in rural areas;
 Health Insurance as a global option for funding healthcare services;
 The limited scope of coverage of National Health Insurance Scheme {NHIS} and its
restricted drug lists;

Training Workshop on Attitudinal Change: The Framework for Effective Service Delivery in the Health Sector 3
 Participants observe:
 Government’s efforts in providing healthcare services to her citizens though not
adequate;
 Inadequate budgetary allocation to the Health Sector which presently is less than 6%;
 Untimely release or in some cases non release of budgetary allocations for healthcare
services;
 Inadequate collation and utilisation of health data;
 The low level of ICT deployment in healthcare institutions in Nigeria;
 The non implementation of the National Health Act.
 The challenges of service delivery infrastructure in Nigeria which include, access
roads, power and security;
 The non-sustainability of Donor Agencies funded programmes;

Recommend that:
 Healthcare providers should imbibe good ethical values and exhibit professional
conduct that are in line with global best practices;
 Proper recruitment and placement of healthcare personnel should be adopted to
enhance quality healthcare service delivery;
 Primary Health Centres should have full complement of health Personnel.
 Adoption of more efficient and transparent approaches to healthcare service delivery
in Nigeria;
 The Medical Governing Boards/Councils should comprise of notable persons with
requisite professional qualifications and reputable integrity;
 The Government at all levels should embark on capacity building of healthcare
personnel to further enhance productivity;
 Governments should increase the budgetary allocation to the Health Sector at least up
to the minimum of 15% recommended by WHO and the African Heads of State;
 Immediate implementation of the provisions of the National Health Act;
 Provision and maintenance of infrastructural facilities in healthcare centres across the
country;
 ICT should be integrated into the healthcare service delivery with increased research
and innovation to enhance its quality;
 Government should adopt a holistic approach to address the incessant industrial
disharmony among the unions in the Health Sector;
 Government should establish Hospital Intervention Fund;
 Harmonisation of various payment points in healthcare centre into one to check
financial leakages and corruption;
 Public Private Partnerships (PPP) should be encouraged as a strategy to greater access
to healthcare services;
 Explore and deepen partnership opportunities with the Donor Agencies;
 Establishment of Healthcare monitoring mechanisms at all tiers of government;
 Establishment of Service-User Unit as a feedback mechanism on the quality of
healthcare service delivery;
 Reward and punishment systems should be vigorously implemented in all healthcare
institutions;
 Implementation of Social Insurance Scheme as it provides wider access to healthcare
services to the general public;

Training Workshop on Attitudinal Change: The Framework for Effective Service Delivery in the Health Sector 4
 Establishment of Special Social Security arrangement based on the concept of Social
Solidarity & Equity to provide financial protection to participants in the event of ill-
health;
 That the Workshop on “Attitudinal Change: The Framework for Effective Service
Delivery of the Health Sector” be organized for the State and Local Government Health
Sector.

Appreciation

Finally, participants express gratitude to the Federal Ministry of Health and the New Era
Global Resources Limited for organizing the 4-Day Workshop on Attitudinal Change: The
Framework for Effective Service Delivery of the Health Sector.

RAPPORTEUR GENERAL

Training Workshop on Attitudinal Change: The Framework for Effective Service Delivery in the Health Sector 5