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Community Health Influencers, Promoters and Services (CHIPS)

ABOUT THE CHIPS PROGRAMME

The Community Health Influencers, Promoters and Services (CHIPS) Programme, established by the National Primary Health Care Development Agency (NPHCDA) and endorsed by the Federal Government of Nigeria, is designed to improve on the Village Health Worker (VHW) concept. It is envisaged that the Programme will help bridge the gaps in access to health care, improve the continuum of care, link households to the healthcare systems, complement national data systems, improve health outcomes, and strengthen the community component of Primary Health Care (PHC), critical to attaining Universal Health Coverage. The CHIPS Programme is structured to stimulate and support households in communities to seek PHC services through various delivery platforms, namely the health facility and outreaches. The Programme also enables clients to obtain essential PHC services, by bringing these services closer to households through home visits by CHIPS Agents, especially in rural underserved communities.

STRATEGIC APPROACH

The strategy is to harmonize existing community-based programmes e.g. integrated Community Case Management of Childhood Illnesses (iCCM), Voluntary Community Mobiliser (VCM), and Village Health Worker (VHW) Programmes, into the CHIPS Programme. This provides a coordinating platform with one training curriculum, one M&E Framework and one category of community-based health workers i.e. the CHIPS Personnel (CHIPS Agents and Community Engagement Focal Persons (CEFPs)). A minimum of 10 CHIPS Agents, preferably females, are selected and trained in each political ward. They work at household level, to provide counselling, create demand and refer household members to PHC facilities for uptake of needed services. In addition, they provide basic promotive, preventive services and case management of uncomplicated cough, diarrhoea and fever in children under five years. The Community Engagement Focal Persons (CEFPs), preferably males, are selected and trained to support the work of CHIPS Agents by promoting male involvement and community engagement and participation in Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) service utilization. They facilitate and track community referrals, and also help with addressing non-adherence to Routine Immunization (RI), Antenatal Care, and other maternal and child health services Critical to the success of the Programme is the availability of a functional PHC in the ward that will serve as the site for referral. The PHC facility serves as the anchor point for CHIPS Personnel management, supervision, and data collation and reporting within the ward. It also serves as an operational logistics hub for the storage and distribution of commodities needed for service delivery.

Principles of the CHIPS Programme

  1. Transitioning of Community Resources

    It is critical that the capacity built and resources invested during the implementation of various specific community health interventions e.g. Polio Eradication Initiative, iCCM, etc. are harnessed, transitioned and leveraged to strengthen the community component of PHC as a whole. Therefore, existing CBHWs are mapped and prioritised for selection as CHIPS Personnel, ensuring existing resources a fully leveraged.
  2. Volunteerism

    Engagement of personnel for the CHIPS Programme, i.e. the CHIPS Agents and Community Engagement Focal Persons (CEFPs) is strictly on volunteer basis. Therefore, no monetary allowance in the form of salary is offered. However, it is recommended that states provide small stipends to CHIPS Personnel to cover their logistics, communication and other programme-related costs.

CHIPS GOVERNANCE AND COORDINATION

  1. National Level
    The CHIPS Programme Implementation Unit is made up of six (6) working groups namely; Operations, Capacity Building, Communication and Demand Creation, Costing & Finance, Female Empowerment, Logistics. The CHIPS PIU, led by the Programme Manager, with oversight and support by the ED/CEO of the NPHCDA, coordinates all CHIPS Programme activities at National level, and supports States in the planning and implementation of the CHIPS Programme. This is done in a multi- stakeholder collaborative approach, working with FMOH, other MDAs, Development Partners, Academia, etc.

  2. State Level
    State CHIPS PIUs, led by the State CHIPS Coordinator, comprises of State Program Officers drawn from relevant thematic areas, with oversight provided by the SPHCDB Executive Secretaries and Directors, drive Programme implementation at the state level, and coordinate, monitor and supervise implementation at lower levels, with support from other MDAs, development/implementing partners, Academia, etc.
     
  3. LGA Level
    An LGA Desk Officer (usually the MCH/RH Officer) is appointed in each implementing LGA to provide daily coordination of the Programme at that level, with oversight from the LGA Health Authority Management Team (LGAHMT).

  4. Ward Level
    Ward Development Committees (WDCs), Community-Based Organisations (CBOs), Civil Society Organisations (CSOs), and Traditional and Religious bodies provide the oversight and monitoring of the CHIPS Programme, while daily coordination and direct supervision of CHIPS Personnel is provided by the supervising Community Health Extension Workers (CHEWs) at the ward Focal PHC Facility.

 

CURRENT STATUS OF CHIPS PROGRAMME IMPLEMENTATION

As at October 2021, 19 States across the country are currently in the implementation phase with all State in various stage ranging from State training of Trainers to full deployment of CHIPS Personnel.

  • 13 States have completed the training of a total of 8,289 CHIPS Agents and 1,218 CEFPS across 145 LGAs in 886 Wards.
  • 8 states – Nasarawa, Niger, Kano, Gombe, Yobe, Sokoto, Kaduna and Borno have deployed CHIPS personnel
  • 5 states – Adamawa, Bauchi, Osun, Ebonyi & Jigawa have completed training of selected CHIPS Personnel but are yet to deploy to commence service provision
  • An additional 702 CHIPS Agents and 120 CEFPs have been selected in 3 States (Taraba, Ondo & Kwara), across 21 LGAs in 54 wards
  • Abia has conducted STOT, while the activity is ongoing in Delta & Kastina States

The National CHIPS PIU is engaging with other states (17 States and FCT) to commence planning for implementation of the CHIPS Programme. Each state has been assigned state support officers and assisting state support officers to provide technical guidance for the development of an implementation work plan.

KEY CHIPS PROGRAMME ACTIVITIES

iCCM–CHIPS Harmonisation

Implemented by the FMOH under the Child Health Unit of the Department of Family Health Services, iCCM is a global strategy that seeks to expand access to treatment of leading childhood killer diseases – malaria, pneumonia and diarrhoea in especially hard to reach areas where children under five lack access to health facilities. The strategy uses lay trained community health workers, named CORPS who are trained to diagnose these conditions and provide appropriate therapy.
 
At the sub-national level, NPHCDA has been working assiduously, with state and non-state actors, to integrate all community based health workers, including CORPs, to ensure the actualization of the CHIPS Programme, in line with the Presidential mandate. To support this process, the Honourable Minister of Health directed the harmonisation of the two programmes, ensuring iCCM is fully integrated into the CHIPS Programme at the National Policy and Strategy level.
The NPHCDA and Department of Family Health at the FMOH have collaborated over the last several months, with other stakeholders from MDAs, Academia, Partners, etc. to operationalise this; the results of which are a set of comprehensive, harmonised CHIPS Documents that will serve as the roadmap for implementation of all community health worker programming in the country. A draft document was developed after a validation workshop held on 25th – 27th October 2021 in Lagos State. This document will be finalised and launched by December 2021.

CHIPS PROGRAMME PILLARS AND PRINCIPLES

The CHIPS Programme has two pillars: the Health Pillar and the Female Empowerment Component; and several principles, including Transitioning of Community Resources and Volunteerism.

Pillars of the CHIPS Programme

  1. Health Pillar
    The key work of the CHIPS Personnel is to generate demand for health service utilization at the health facility and promote healthy lifestyle practices, using various interpersonal communication strategies and behavioural change communication at household and community levels. They link communities to primary health care services by facilitating referrals, and ensure appropriate follow-up. CHIPS Personnel also provide basic treatment to children under 5 for common childhood illnesses.

  2. Female Empowerment Pillar
    To ensure sustainability of the programme, which is primarily based on volunteerism, strategies have been set up to empower the CHIPS Agents by providing skills acquisition training and literacy schemes. Though CHIPS Agents are supported with stipends to cover transportation and communication costs incurred in the course of service provision, educational and economic empowerment is needed to contribute to their socio-economic
    development, and ensure the CHIPS Agents are fully supported to serve their communities  as volunteers.

CHIPS PROGRAMME PILLARS AND PRINCIPLES

CHIPS Personnel comprise of the CHIPS Agents and Community Engagement Focal Persons (CEFPs)

  1. CHIPS Agents

    CHIPS Agents are members/residents of the community who are nominated, assessed, selected, trained, kitted, deployed, mentored and supervised to provide basic health services through home visits to the members of their community (mainly household), and refer them for appropriate services at Primary Health Care Facilities. They are mainly women, well-respected, able to read and write, good communicators, with
    interest in helping their communities.

  2. Community Engagement Focal Persons
    Community Engagement Focal Person (CEFP) are usually males of 25 years and above, resident in the community, and speak the local language fluently, who provide support to the CHIPS Agents by encouraging male involvement in RMNCAH+N service utilisation, addressing issues of non-compliance and forward unresolved issues to the Ward Heads, facilitate tracking of community referrals, etc. CHIPS Agents and CEFPs are nominated by the community members, Ward Development Committees, and traditional leaders, then selected through a rigorous process using Nationally recommended selection criteria.

GOAL AND OBJECTIVES

The overall goal of the CHIPS Programme is to contribute to reduction of maternal and child morbidity and mortality by improving access to and equitably increasing coverage of basic primary health care services. The specific objectives are to:

Equitably expand access to basic PHC services in Nigeria, especially at the community level

Increase demand for PHC services by individuals and households

Foster community participation and ownership of the Programme

Foster community participation and ownership of the Programme

Promote female empowerment and socio-economic development

Promote public-private partnership in primary health care development, especially at community level

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