Adapting and Diffusing the 72-hour Clinic Makeover Across Northeast Nigeria

Contributors: Rabi Ekele and Yakubu Usman Abubakar

Traditional ruler Alhaji Abdulkadir Umar commissioning the Gombe facility.

TCI’s high-impact proven approach, the 72-hour clinic makeover, is being adapted beyond the 10 states supported by The Challenge Initiative (TCI) in Nigeria, diffusing to 75 facilities in Gombe State in northeastern Nigeria. During a contraceptive technology update organized by Bauchi State, TCI introduced the 72-hour makeover and implementation process to policymakers, technocrats and other implementing partners in the state and invited all of those present and interested to implement the approach.

Planned Parenthood Federation of Nigeria (PPFN) representatives in attendance during the CTU felt that this approach could help them expand access to sexual and reproductive health services in Gombe State by adapting it for one of their projects supported by the Norwegian Government through UNFPA. PPFN asked to observe 72-hour makeovers at five facilities in Katagum LGA in March 2019 to learn and prepare for adapting the approach for its facilities in Gombe State. The PPFN Regional Coordinator, Yusuf A. Wabi, joined the Technical Support Team in Bauchi State during these makeovers and learned firsthand what goes on during implementation. Wabi was specifically interested in understanding the details of the process, such as how to sort and distribute equipment to the facilities, how to bargain with artisans for cost-effective labor and how to carry out structural renovations.

Describing the 72-hour makeover experience in Katagum, Wabi said:

It is a story of impossible to possible. When the concept was mentioned initially that a facility shall be renovated and put to use in only 72 hours, it seemed to me like a joke. However, when the process began, the level of work put in place by the artisans, the control and the monitoring of the work by the team, the procurement of materials and the commitment by the staff changed the narrative. I have seen a facility that I considered to be a moribund facility but has within 72-hours become a new befitting facility anybody can be proud of.”

Wabi also pointed to savings made from direct purchases and importance of community involvement as key lessons from the makeover, saying:

In the five facilities I monitored in Katagum LGA, the work began after close of work on Friday, the artisans were mobilized to the sites, bricklayers started with clearing the site, demolition of the area to be partition as an insertion room, the blocks made available and the construction began before sunset that same Friday. The following day (Saturday) all the issue of purchases was handled by the designated staff and the artisans and the level of savings incurred during the price negotiation is encouraging. The savings made the work motivating because there are instances where something has not been budgeted for initially but may come up but because of the little savings here and there you may as well put the cost of the extra work from the savings made during the purchases. The work continued to the next day which is Sunday, at that level the work become even more interested with a renewed commitment from the community representatives and the staff including the artisans themselves. In fact, you can see clearly from their faces because they have that impression of owning the process, it is their facility, it is their families who are the direct beneficiaries and by Monday morning all sites have been completed, cleaning has been done and equipment has been put in place and the entire facility became new and ready for Inauguration. The 72-hour makeover is a success story, in fact the level of commitments by the team is unprecedented.”

Excited by this experience and empowered with his firsthand knowledge, Wabi returned to PPFN and shared what he learned with his team. PPFN then conducted a performance improvement assessment in Gombe State and identified the first batch of facilities planned for makeovers.

PPFN reached out to TCI requesting technical assistance in the form of on-the-ground supervision and coaching for three makeovers planned for July 5-7, 2019. The facilities were successfully made over, with minimal support from TCI, and were officially commissioned by the traditional ruler from the Gombe Emirate Council, Alhaji Abdulkadir Umar – Yariman Gombe, who is known for his commitment to promoting family planning services in the state. The commissioning ceremony took place on July 8, 2019, at Gabukka PHC, one of the three renovated facilities.

Traditional ruler, Alhaji Abdulkadir Umar – Yariman Gombe, flanked by PPFN’s Advocacy Director and other PPFN staff at the commissioning of three facilities in Gombe State.

During the commissioning, Umar told community residents to take advantage of the improved quality, more private child birth spacing (CBS) services available to them at these renovated facilities. He pointed out that “It is necessary for every family to adopt a method and remain mutually responsible in bringing up their children.” He also advised the state government to take greater responsibility for providing access to quality health care services and ensuring adequate budgetary allocation and release of funds, especially for CBS services. PPFN’s Advocacy Director from Abuja attended the commissioning ceremony and lauded the efforts of Gombe State Government and its citizens. He thanked TCI for the support provided despite short notice that made the whole exercise a success.