US embassy cable - 04ABUJA2152

UNCLAS SECTION 01 OF 03 ABUJA 002152 
 
SIPDIS 
 
DEPT FOR AF/W 
USAID/W FOR AFR/AA, LLOYD PIERSON 
USAID/W FOR AFR/WA, NEIL WOODRUFF 
GH/AA, LINDA MORSE 
GH/CH SURVIVAL, HOPE SUKIN 
OES/IHA 
 
E.O. 12958: N/A 
TAGS: PGOV, EAID, SOCI, NI, HUMANRIGHTS 
SUBJECT: NIGERIA: BASICS II CONTRIBUTION TO CHILD 
SURVIVAL IN NIGERIA 
 
REF: ABUJA 001770 
 
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SUMMARY 
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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 
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BACKGROUND 
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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. 
 
 
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ACHIEVEMENTS 
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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) 
facilities. 
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. 
 
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DISCUSSION 
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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. 
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MILLENNIUM DEVELOPMENT GOALS 
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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. 
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CONCLUSION 
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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. 
 
FUREY