NIGERIA STATE HEALTH INVESTMENT PROJECT IN NASARAWA STATE – Update on NSHIP activities Presented: December, 2016

Objective of NSHIP To increase the delivery and use of high impact maternal and child health interventions and to improve the quality of care at selected health facilities in the participating states.

NSHIP DEVELOPMENT INDICATORS Proportion and number of 12-23 month old children fully immunized; Proportion and number of births attended by skilled health providers; Average of Health Facility Quality of Care Score; Number of outpatient visits by children under five; and Direct Project Beneficiaries (2,469,175), of which 53% are female.

The project consists of two components : PROJECT COMPONENTS The project consists of two components : Results Based Financing (RBF) – PBF and DFF. Technical Assistance (TA) – State and National The RBF component has two sections: Strengthening Service Delivery mainly at the health facility level Strengthening Institutional Performance at the Federal, State and LGA levels. The TA component supports the implementation of the RBF at LGA, State and National levels

UPDATE ON NSHIP ACTIVITIES – July to September2016 Coaching and Mentoring of health facilities on Business Plan development – Recurrent Monthly Quantity verification of PBF facilities – Recurrent Quarterly LGAs Steering Committees meetings and Assessment of HMB and LGAs PHCDs – Recurrent Quarterly Payment of Bonuses /subsidies to beneficiaries -Recurrent Mentoring and coaching on financial and procurement managements – Recurrent Technical Working Group and State Steering Committee Meetings – Recurrent Advocacy visits to key stakeholders – Recurrent

UPDATE ON NSHIP ACTIVITIES – Cont ………. Launch of DSF in Wamba in November, 2016 Capacity building of health workers on IMCI, Data validation, HCWM, TPM, and participation in National meetings Financial management training in Kokona LGA Participation in NSHIP 2016 Detailed Implementation Plan (DIP) development

Continuation of Household Numbering report by LGAs UPDATE ON NSHIP ACTIVITIES – Cont ………. Continuation of Household Numbering report by LGAs Quantity counter verification (Community Client Satisfaction Survey) Finalization for the engagement of communication consultant and M&E specialist for SMOH Stakeholders meeting with LGA IMC Chairmen NSHIP Mission to the state and performance review of project with focus on Hospitals Radio programmes and TV sections in view

Activities Gallery

Challenges to Health system and RBF implementation in Nasarawa State Weak supervision of health facilities by LGA PHCD, SPHCDA and HMB Misapplication of funds at health facilities and poor of implementation of audit procedures by the state and LGAs and non enforcement by supervisors eg Nasarawa and Kokona LGA Audit report Poor implementation of strategies in business plans by health facilities and no enforcement from supervisors. Security challenges are still affecting some wards in the State especially in Doma and Nasarawa LGAs.

RECOMMENDATIONS There is need for the PHC departments to continuously build the capacity of health facilities in the areas of data management and treatment protocols and service delivery guidelines. Capacity building of the PHC department team and HMB teams and health facilities managers to improve their managerial and supervisory capacity. PBF to stimulate demand for low performing services . Health worker streamlining should be done in consultation with the project staff to minimise the effect of capacity gaps at contracted health facilities. Health facilties to continuously improve the quality of care

LGA NO OF HFS AMOUNT BUDGETTTED Quality Score Amount Earned Nasarawa 39 3722791.8 88% 3276056.784 Toto 31 2959142.2 61% 1805076.742 Doma 37 3531879.4 86% 3037416.284 Akwanga 30 2863686 60% 1718211.6 Karu 66 6300109.2 64% 4032069.888 Wamba 20 1909124 1680029.12 Kokona 29 2768229.8 1771667.072 keffi 17 1622755.4 5% 81137.77 Awe 24 2290948.8 114547.44 Lafia 57 5441003.4 272050.17 Nasarawa Eggon 35 3340967 37% 1236157.79 Keana 21 2004580.2 100229.01 Obi 6% 171821.16 HMB 59% 957425.686 TOTAL 453 43241658.6 20253896.52

NSHIP MSSIOM AIDR MEMOIRE Poor Management of General Hospitals Lack of logistics for supervision Lack of support to HMB and SPHCDA for supervision from DLI fund Poor service indicators and quality of General Hospitals Commended the state for autonomy of DRF management by Hospitals Poor performance in the area of Family planning uptake by the state Negative effect of strike on health service delivery

ACTIVITIES NOT ACCOMPLISHED FOR 2016 Quarterly quality counter verification Second PBF internship Programme Training on emergency Gynaecological and obstetric care for PBF and DFF Health facilities Essential drugs and clinical management training

THANK YOU!