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;

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.

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.

Multi-stakeholder representatives at iCCM-CHIPS Harmonisation Validation Workshop

Ongoing State Implementation Activities

1. Selection and Training of CHIPs Personnel in Kwara State and Ondo State

A facilitator taking a session on counselling, with participants (CHIPS Agents, CEFPs and Supervising CHEWs) listening keenly at the 2-week ward level training of CHIPS Personnel in Kwara State which began on the 25th of October 2021

State Facilitator addressing CHIPS Personnel during 2-week Ward Level training in Kwara State commenced 25th October 2021

Role Play being conducted by CHIPS Agents during 2-week Ward Level training in Kwara State commenced 25th October 2021

Practical session on community mapping during the 2-week ward level training of CHIPS Personnel in Kwara State commenced 25th October 2021

Practical session on community mapping during the 2-week ward level training of CHIPS Personnel in Kwara
State commenced 25th October 2021

CHIPS Agent conducting MUAC measurement on a client on community visit during CHIPS Personnel training in Kwara State

2. State Level Training of Trainers in Delta State and Katsina State

A National Facilitator (Course Director) addressing State participants at the 2-week STOT in Delta State commenced 25th October 2021

The Delta State participants doing the pre-test at the 2-week STOT in Delta State commenced 25th October 2021

Role play on conducting home visits during the ongoing 2 weeks State level training of trainers in Delta State which commenced 25th October 2021

A participant demonstrating kangaroo mother care method during 2-week STOT in Katsina State commenced 18th October 2021

Demonstration on the proper application of chlorhexidine gel during SToT in Katsina State commenced 18th October 2021

3. Selection and Training of additional CHIPS Personnel in Kaduna and Borno State

Participants adhering to hand washing guidelines during the 2-week training of additional CHIPS Personnel in Kaduna State commenced on 25th October 2021

National Facilitator taking participant through a session during the 2-week ward level training of additional CHIPS Personnel in Kaduna State commenced on 25th October 2021

Advocacy visit and community engagement during community entry for CHIPS Personnel training in Kaduna State commenced 25th October 2021

Advocacy visit to District Head of Buratai in Borno State during selection of CHIPS Agents commenced 25th October 2021

CHIPS Agents selection at Gomari ward in Borno State commenced 25th October 2021

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
Promote female empowerment and socio-economic development
Promote public-private partnership in primary health care development, especially at community level

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 PERSONNEL

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.