TCF with its considerable experience in PHC in Nigeria undertook the responsibility of coordinating and monitoring the project through a full time program manager. The many positive experiences in PHC acquired by the TCF in the past were incorporated into the project as key strategies for the success of the project.

Primary Health care is basic fundamental health care, which should be available to all people rural or urban. The level of facilities may of course depend on the resources (personnel, money etc) in the particular community. In the rural areas of Nigeria, PHC services would look at providing basic health care services, which can upgrade the quality of the people. Maternity services, infant health care and health care to children under the age of five are not a luxury but an essential need of all communities. In addition the access to essential drugs by all people in the community is a human right.

TCF with its many years of experience in health care in rural Nigeria has over the years come up with a comprehensive Primary health care process that is cost effective. The TCF plan differs from other similar projects in the following ways:

1. Provision of a village health worker called the health attendant who is trained and is on a regular salary.
2. Community organizations (PHC, Health Clinic and Village development Committees) assisted by a full time Program Manager to help in the development of systems in addition to ensuring the prompt and regular supply of materials, drugs and equipment.
3. Helping staff mobility by assisting them to acquire motorcycles and provision of fuel allowances.
4. Reorienting and retraining existing LGA staff to take on a comprehensive role of a primary health care provider and a supervisor.
5. Liaison between the Federal, State, Local Governments and the community to facilitate the input of appropriate resources into the service area.
6. Subsidizing health care to vulnerable groups in the community like the pregnant women, infants and under five children.

Over the last three years, the staff deputed to the project has imbibed some of the values propagated by TCF. They are now able to visualize themselves as supervisors and are fulfilling some of their responsibilities.

These agencies are largely uninvolved in the day to day running of the project. The role of the NPHCDA is limited to occasionally conducting workshops for the staff.

Community Participation in PHC can be measured in terms of the community providing resources like money, material or personnel and also the utilization of services. At the initiation of the project, the communities were very excited to have a health program in their villages. Committees were formed and the initial discussions were quite successful. The community agreed to provide a building for the health post and also accommodation for the health attendants. The District Heads took significant initiative in embracing the project and directed their village chiefs to cooperate. The selection of the sites for the three Health Clinics and the first 12 Health Post villages was done by the full cooperation of the Community. Similarly the selection of the health attendants for training was also with the involvement of the community. Once the health attendants were trained, the community acquired simple buildings to house the health posts and also provided accommodation for them.

Currently community involvement is seen in the form of giving the necessary buildings to house the Health Posts. However utilization of the services is encouraging and it is hoped that with the inclusion of more women in the committees they will take up the initiative of meeting regularly to guide the Health Posts in the future.

In these three years, almost all the objectives have been fulfilled to a large extent. Statistics show a progressive improvement in service delivery and also health status. Key activities like antenatal care, delivery care, postnatal care, infant immunization, growth monitoring of under-five children and home visitation have improved considerably. Vital statistics like infant and maternal deaths are very low when compared to national or zonal figures. The health attendants are able to fulfill their role as envisaged in the MOU. Communities are very appreciative of the presence of the H/Posts and the health attendants in their midst.

LGAs accept the fact that the results shown by the project are commendable. Many other LGAs in Kaduna State have made enquiries about how to take up such a project in their own areas. The State and Local Government health functionaries are universally in agreement that all aspects of PHC are being addressed successfully though the Project.

• Three new health posts were established to bring the total number to 30 as planned.
• The health management information System has been strengthened to provide weekly and monthly project data.
• A new batch of 15 health attendants were trained and posted for apprenticeship.
• The laboratory at Gidanjibir PHC Center has been equipped and stocked and is running well.
• The PHC Working Committee (Ward Development Committee) is meeting regularly at Gidanjibir PHC Center every month and issues are being discussed. This is positive step towards future community control of the project
• A Project Appraisal Document was prepared and handed over to the NPHCDA. The Project was appraised by a team from NPHCDA and multilateral agencies in November 06
• TCF employed a full time project doctor by the NGO in November 06. The Doctor resides at Gidanjibir village and is available round the clock. He divides his time between taking care of out patients and inpatients at the PHC center and also making visits to the health clinics and health posts.

• Increase efforts at community mobilization to help people to understand concept of ownership of the project.
• Increase efforts at further reducing infant and maternal Mortality.
• Streamlining the Drug Revolving Fund activities
• Communications with State and Local Governments on staff deputation. LGA special activities like NID to be coordinated with project schedules to avoid duplication of efforts.
• Discussions with NPHCDA on better coordination of all activities involving project staff or project areas.
• Discussion with State Government on resources earmarked for project area and how they may be directed to the Project.

The Kachia PHC Project is now in its fourth year. Since its initiation in 2003, the project has evolved to its complete organizational structure of 30 health posts supervised by three health clinics under one PHC center. TCF has managed to build up this structure with help from the community and is endeavoring to provide quality health care to the people. All the systems and strategies of health care delivery, tried and tested by TCF over the years are in place and working to the satisfaction of all involved especially the beneficiary communities.