Application of Bottleneck Analysis (BNA) Methodology for Primary Healthcare Review in Kebbi State Nigeria

Strengthening service delivery is a key strategy to achieve the Sustainable Development Goals. This includes the delivery of interventions to reduce child mortality, maternal mortality, and the burden to HIV/AIDS, tuberculosis and malaria. Service provision is a product of three key determinants – Health Workforce; Commodity (including infrastructure, equipment, medical supplies, and finances for their synergetic functioning); and accessibility (including geographical and financial accessibility to services by clients). While applying a linear simplistic perspective, inputs lead to commensurate outputs within an enabling environment, and increased input lead to increased output – or in this context, increased capacity for service delivery and enhanced access to services. It is therefore imperative that health system actors conduct periodic review of the health system to enable them draw counter-intuitive insights on what constraints exist and to what degree, which hinder achievement of predetermined goals. The bottleneck methodology provides a model for health managers to review the adequacy of inputs (supply-side determinants) in relation to set standards and the performance of the outputs (demand-side determinants) in relation to uptake expectation per target population. The European Union-funded Maternal, Neonatal & Child Health plus Nutrition (MNCH+N) program in Nigeria supported the Kebbi State Primary Health Care Development Agency to conduct the first quarterly PHC Review using the revised Nigerian Bottleneck Analysis model in third quarter of 2018. The review also focused on the development of plans of action aimed at addressing some of the identified gaps. Findings show that coverage for under-five-year-old expected cases as follows; 22,497 diarrhoea new cases, 4,845 pneumonia new cases and 70,423 fever cases were identified and managed by health care workers at fixed and mobile posts. This represents 3.63%, 11.11% and 10.56% cases for Diarrhoea, Pneumonia and Fever respectively were identified, out of expected episodes per child in 2019.