A

TERM PAPER

ON

ANALYSE THE ROLE OF EVIDENCE-BASED DECISION MAKING IN SHAPING

BY

LAWRENCIA EMINUE

SUBMITTED TO

DR. ETIM FRANK

APRIL, 2025
INTRODUCTION

Akwa Ibom State is located within the South – Eastern axis of Nigeria and is now a part of the

South South Geo-Political zone. Created on 23rd September, 1987 by the Government of

President Ibrahim Babangida out of the former Cross River State Akwa Ibom state is made up

of 31 Local Government Areas, further divided into 329 political wards. The state has a land

mass of 8,412 sq.km, bounded to the north by Abia State, to the east by Rivers State, to the

west by Cross River State, on the sandy coastal plain of the Gulf of Guinea and to the south by

Atlantic Ocean which stretches from Ikot Abasi to Oron. The state has a Population of

4,333,819 million, Male: Female Ratio, 50.82: 49.18; out which 85% live in the rural areas.

With Uyo as the Capital City, other urban cities are Eket, Ikot Ekpene, Abak, Ikot Abasi and

Oron. The state is made up of a number of ethnic groups; Ibibio, Annang, Oron and other

minor groups. With an ocean front which spans a distance of 129 km coastline which is not

only the longest in the country, but is also a very rich source of a wide variety of fishes and

seafood including catfish, barracuda, blue marlin, squid, sardine, croakers, shrimps, prawns,

crayfish, snapper, bivalves and oysters from Ikot Abasi in the west to Oron in the east, Akwa

Ibom presents a picture of captivating coastal, mangrove forest and beautiful sandy beach

resorts.

The State is endowed with Mineral Resources, including Crude oil, natural gas, limestone,

gold, salt, coal, silver nitrate, glass sand, kaolin. As one of the three largest producer of crude
oil in Nigeria, Akwa Ibom State is one of the most important economic resource bases of the

Nigerian Nation. The State is host to Mobil Producing Nigeria Unlimited, a subsidiary of

Exxon Mobil Corporation, Aluminium Smelter Company of Nigeria (ALSCON) and Champion

Breweries, Nigeria among others, and is also a catchment neighbor to Nigeria’s Export

Processing Zones (Oil and Gas) in Ikot Abasi, Mbo and Calabar, and boast of Industrial Estates

in Uyo and Ikot Ekpene.

The life expectancy at birth is 49 years while the disability adjusted life expectancy at birth is

38.3years; vaccine-preventable diseases and infectious and parasitic diseases continue to exact

their toll on health and survival of Akwa Ibomites. Though there has been no state specific

population based survey, but relying on the validity of the current National Demographic and

Health Survey (NDHS) 2008, The Crude Birth Rate is 32/1000, while the Crude Death Rate is

12/1000. Similarly, Infant Mortality Rate stands at 84/1000 live births; Under 5 mortality -

138/1000 pop; HIV Sero-Prevalence Rate – 9.7; Maternal Mortality Ratio - 545/100,000; Total

Fertility Rate - 4.6. Sixty six percent of women giving birth in the last five years received

Antenatal care from a qualified health professional while maternal and childhood malnutrition

stand at 11% and 18% respectively.

The common causes of illnesses include; Malaria, Helminthiasis, Gastroenteritis, Respiratory

tract Infection, Anaemia, Malnutrition, Hypertension, Diabetes Mellitus, Arthritis,

Tuberculosis, Typhoid Fever, HIV Infection, Hepatitis, Impaired Vision, Cancer. Whereas the
Common causes of death include; Malaria, Hepatitis, Diabetes, Hypertension, Road Traffic

Accident, Post Partum Haemorrhage, Neoplasm/Cancers, Gastroenteritis, Ante Partum

haemorrhage, Unsafe Abortion, HIV/AIDS, Infection Septicaemia, Severe Anaemia,

Respiratory tract Infection, Ruptured Ectopic Pregnancy and Obstructed Labour.

The State allocation to health in 2006 stood at N3.85bn, representing 3.25% of total budget of

the state, out of which only N0.98bn was actually released. Whereas in 2008, N10.25bn or

4.0% of total state budget was allocated to health with only N3.9bn actually released. Akwa

Ibom State has a total of 182 medical doctors, 3 dentists, 1940 Nurses/Midwives, 31 Medical

laboratory Scientists,19 Medical laboratory Technicians, 36 Pharmacists, 24 Pharmacy

Technicians, 238 community Health workers, 3 Radiographers, 79 Medical record Technicians,

12 X-Ray Technicians, 3 Ophthalmic Opticians and I Ophthalmologist. These are spread across

the 383 Public Health facilities in the state. The state also has 232 registered private health

facilities. To enhance capacities, in 2008, the Hospitals management Board sponsored a

Manpower Development/Personnel training which involved 33 Medical Doctors including 20

House officers in Teaching hospitals and 75 other health workers. Similarly, 10 Doctors, 45

Nurses & other support staff variously participated in short courses and Personnel trainings

sponsored by SMOH. Overall 50 staff of the Ministry of Health have undergone computer
appreciation trainings.

The implementation of the ward minimum health care package is just beginning in the state

with the Federal Model PHC’S. Hence, the minimum personnel requirement is still an issue to

be attended. All the 31 LGA’s are currently running outreaches in order to reach out to the

communities in the riverine and difficult terrains.

From the bottleneck analysis, the following problem areas were identified:

Whereas political will exist, it is not translated to adequate and timely release of funds in

support of health programmes especially at the Local Government Area levels. This invariably

cuts across other area as listed below. There are inequitable distributions of Health Centers in

all the Political Wards of the State. There would be need to ensure that every Political Wards

has a health center. Most of the health centers do not have adequate manpower to provide

services. There would be need to recruit more personnel to provide services. Consequently,

there is a precarious scenario of Doctor population ratio of 1:24,000 and a Nurse population

ratio 1:1,500.

There is need to provide quality services by ensuring that staff are trained and re-trained in

relevant areas. Balance distribution of staff especially to serve in rural areas rather than

concentrate in urban centers would be need to be addressed. Most health centers do not have

basic medical equipment. Lack of adequate storage facilities especially for vaccines and cold
chain equipment were identified. There are no utility vehicles to support logistics of materials

movement, effective monitoring and supervision.

Effort is still being made to provide each LGA with the Health Management Information

System (HMIS) minimum package. This effort would be intensified in order to make the

availability of the minimum package a reality in the first year of this plan. HMIS monitoring

system would be strengthened through provision of vehicles, equipment and training and

re-training of staff to provide the required quality health data.

Ward Development Committees would be constituted and other structures as laid down in the

Ward Minimum Health Care Package. The focus is to enhance community participation and

ownership of intervention and programmes in all the 31 LGAs with involvement of community

members in health decisions.

The State’s minimum package of care shall address care during pregnancy, during labour, at

birth and Postnatal/Newborn care, Care during infancy and childhood among others. Under

Care during pregnancy, the package of interventions include the following: Antenatal care

package which contains the following high impact interventions Tetanus toxoid immunization,

Birth and emergency planning, detection and management of complications, detection and

treatment of syphilis, intermittent prophylactic treatments (IPT) for malaria, sleeping under

insecticides-treated net and prevention of mother-to-child transmission of HIV (PMTCT).

care at birth which contains the following high impact interventions; monitoring progress

during labour, Social support (Companion) during birth, immediate newborn care (resuscitation

if required, thermal care, hygienic cord care, early initiation of breastfeeding). Another

package of intervention is Emergency obstetric and newborn care which contains detection and

clinical management of obstetric and newborn complications. Under Postnatal care of mother

and newborn, the package of intervention is routine postnatal care of mother and newborn

which contains the following high impact interventions; Exclusive breastfeeding, thermal care,

hygienic cord care, extra care of LBW infants, prompt care-seeking for illness, immunization and

management of newborn illness. Under Care during infancy and childhood, the package of

intervention are Community case management of diarrhea, pneumonia, and malaria

,IMCI(first-level facilities) of Algorithm-based management of diarrhea (with ORT and

ZINC0, pneumonia, malaria, malnutrition and newborn illness; care for HIV-exposed and

infected children, IMCI (referral level) contains management of severe newborn and child

illnesses , and Community IMCI which contains community-mobilization and communications

to promote: exclusive breastfeeding, complementary feeding, water, sanitation and hygiene,

care-seeking for preventive interventions (e.g. vaccines), home care for illness and EPI which

contains delivering of essential vaccines.

Through the review of technical resource materials, wide consultations and participatory
techniques, the AKSHDP has been written around the NSHDPf eight priority areas namely:

leadership and governance, service delivery, health financing, human resources for health,

health information system, community participation and ownership, partnerships for health

development and research for health. The plan describes in detail recommended

evidence-based and cost-effective interventions required to deliver improved performance of

the health system and health outcomes for all Akwa Ibomites and include Improving Strategic

Planning at the State and LGA levels, strengthening regulatory functions of government,

improving accountability and transparency, improving and maintaining sectoral Information

base to enhance optimal performance of the health system all of which can be situated in the

leadership and governance function. Further to this the plan recommends the provision of

essential health care service package, strengthening of specific communicable and non

communicable disease control programmes. Also efforts will be directed at ensuring that

Standard Operating Procedures (SOPs) and guidelines are available for delivery of services at

all levels. In the same vein, improvements of the geographical equity and access to health

services will be given priority attention.

Furthermore, the plan provides for ensuring the availability of drugs and equipment at all

levels, establishment of a system for the maintenance of equipment at all levels, strengthening

of the referral system, fostering of collaboration with the private sector, strengthening of
professional regulatory bodies and institutions as well as development and institutionalization

of quality assurance models. Deliberate efforts will be geared to institutionalizing Health

Management and Integrated Supportive Supervision (ISS) mechanisms, the creation of

effective demand for services, including improvements in financial access especially for the

vulnerable groups. Recognizing the need to harness and leverage all resources at the State’s

disposal, the plan outlines the need to develop and institutionalize the Human Resources Policy

framework, reappraise the principles of health workforce requirements and recruitment as well

as equitably distribute, in the right mix, of the right quality and quantity of health professionals

in the state and all the LGAs.

For some time now, practical steps have been taken by the state Government to create the

requisite environment that promotes and sustains the building of a private sector led economy,

tailored towards global market competitiveness and taking advantage of her natural

endowments, namely;

● Building world class infrastructure

● Developing a strong service sector; creating the right institutional framework;

● Investing in the development of key infrastructure comprising power (Electricity),

water supply, communication, transportation mode (land, water and air) housing and

urban development.
Specifically

● The Ibom Power Plant built at Ikot Abasi is designed to provide 685MW with an initial

energy output of 191MW in the first phase of which 60MW (of this power) is dedicated

to meet the State’s current and future energy needs. Currently, over 70% of the State

has been linked to the national grid, while target date for full electrification of Akwa

Ibom State is December 2010.

● The Ibom Airport project has facilities for aircraft Maintenance, Repairs and Overhaul

(MRO)

● The 120 exquisite / Standard rooms Five Star Hotel, with its complementary 18-hole

international standard Golf course, the Marina beach and its inspiring neighborhood;

the Ibaka Deep Sea Port Development

● The Science and Technology / ICT Park

● State University, a trading floor of the Nigerian Stock Exchange, building of a banking

district. Currently 22 of the 24 banks in the country are doing business in the State.

● Large scale construction, rehabilitation, completion and expansion of urban and rural

roads.

● The provision of portable water across the State.

The State government is implementing a wide range of reforms and has evolved targeted
Medium Term Sector Strategies (MTSS) to responsibly exploit these vast resources. Akwa

Ibom also offers a wide range of incentives prompt allocation of plot(s) anywhere in the State

for Industrial, commercial, agricultural and residential purposes. Certificate(s) of Occupancy

for such plot(s) are issued within one month of approval. The State also facilitates and assists

in the collection of all permits, licenses and ensures all documentation needed by prospective

investors in the State. Akwa Ibom Investment and Export Promotion Council (AKIIPOC) offer

a one-stop window on business facilitation. Akwa Ibom beckons. Explore Akwa Ibom.

Conclusion

Evidence-based decision-making plays a crucial role in shaping public policy in the healthcare

sector in Akwa Ibom State by providing policymakers with data-driven insights to inform their

decisions and improve healthcare outcomes. By relying on evidence, policies can be more

effective, equitable, and tailored to the specific needs of the population.