NIGERIA STATE HEALTH INVESTMENT PROJECT IN NASARAWA STATE – NSHIP PROGRESS REPORT PRESENTATION Presented: March, 2017

STATE BACKGROUND State Population 2,523,592 With growth rate of 3.2% 2 tertiary Hospitals State Population 2,523,592 With growth rate of 3.2% 13 LGAs with 147 political wards 18 Secondary Hospitals 12Hospitals contracted under PBF 5 Hospitals contracted under DFF 728 Public PHCs 235 PHC contracted under PBF 185 PHCs contracted under DFF 232 subcontracted under PBF 14 Urban PBF (private health clinics)

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.

PROJECT COMPONENTS The project consists of two components : Results Based Financing (RBF) – PBF, DFF and DLI. Technical Assistance (TA) – State and National The RBF component have two purposes: Strengthening Service Delivery mainly at the health facility level (PBF and DFF) 2. Strengthening Institutional Performance at the Federal, State and LGA levels (eg DLI). The TA component supports the implementation of the RBF at LGA, State and National levels

UPDATE ON NSHIP ACTIVITIES January to December2016 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, TPM, and participation in National meetings Participation in NSHIP 2016 Detailed Implementation Plan (DIP) development Household Numbering by LGAs PHCDs and Health facilities Quantity counter verification (Community Client Satisfaction Survey) The engagement of communication consultant and M&E specialist for SMOH

UPDATE ON NSHIP ACTIVITIES – Cont.. Stakeholders meeting with Hon. Commissioners, PS House of Assembly Committee on Health, IMC Chairmen, Development partners, PHCC etc. National NSHIP Mission to the state and Performance review of project with focus on Hospitals NSHIP Radio and Television programmes to create awareness 2015 NSHIP Annual report publication

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State performance review

STATE AND LGA DLI EARNED SO FAR

STATE DLI PAYMNET S/N YEAR STATE 13 LGAS TOTAL COMMENTS 1 2012 $450,000 $650,000 $1,100,000 Lost of $50, 000 for non availability of SPHCDA/SMoH Website 2 2014 $500,00 $1,150,000 Total amount earned 3 2015 $500.00 $650,000 $1150,000 Total amount earned

Financial Disbursement to HFs Q1 to Q4 2016 LGAs Quarter I INVESTMENT FUND NEW HFs Quarter II Quarter III DSF Quarter IV Total Akwanga 19,050,660.00 8,027,250.00 26,492,390.00 26,713,703.00 43,866,162.00 124,150,165.00 Doma 21,372,754.00 11,495,250.00 21,979,996.00 29,420,021.00 44,974,950.00 129,242,971.00 Karu 25,448,206.00 22,689,000.00 43,809,030.00 72,478,666.00 87,723,396.00 252,148,298.00 Kokona 13,418,065.00 6,274,750.00 20,889,221.00 26,143,909.00 31,608,267.00 98,334,212.00 Nasarawa 26,106,668.00 10,416,750.00 9,009,051.00 10,632,309.00 26,930,053.00 83,094,831.00 Toto 21,430,505.00 9,551,000.00 15,432,833.00 30,785,555.00 43,347,169.00 120,547,062.00 Wamba 27,742,014.00 4,504,500.00 28,282,810.00 32,837,242.00 5,000,000.00 46,108,788.00 141,975,354.00 Awe 10,837,861.00 6,006,000.00 9,347,913.00 17,712,461.00 14,434,196.00 58,338,431.00 Keana 8,713,610.00 4,620,000.00 7,499,002.00 11,375,853.00 9,639,669.00 41,848,134.00 Keffi 10,827,276.00 1,944,250.00 8,427,333.00 11,625,417.00 10,686,461.00 43,510,737.00 Lafia 24,738,032.00 12,714,000.00 20,756,191.00 32,935,396.00 44,297,619.00 135,441,238.00 Nasarawa Eggon 16,879,022.00 7,449,750.00 14,517,603.00 20,192,011.00 18,185,388.00 77,223,774.00 Obi 14,054,195.00 8,566,250.00 12,158,083.00 18,987,639.00 17,801,181.00 71,567,348.00

PHCD Disbursements from Q1 - Q4 2016 PBF PHCDs/HMB Payments No of HFs Q1 Q2 Q3 Q4 TOTAL Akwanga 30 317,500.00 850,000.00 1,718,212.00 2,404,071.00 5,289,783.00 Doma 32 292,500.00 1,120,000.00 3,037,416.00 2,920,219.00 7,370,135.00 Karu 66 425,000.00 18,180,000.00 4,849,854.00 4,220,003.00 27,674,857.00 Kokona 29 340,000.00 970,000.00 1,771,667.00 1,162,362.00 4,244,029.00 Nasarawa 39 237,500.00 1,206,500.00 3,276,057.00 3,424,100.00 8,144,157.00 Toto 286,250.00 1,007,000.00 1,805,077.00 1,863,787.00 4,962,114.00 Wamba 20 504,000.00 700,000.00 1,680,029.00 1,641,430.00 4,525,459.00 HMB 17 1,000,000.00 635,606.00 957,426.00 955,181.00 3,548,213.00

DFF PHCDs Payments No of HFs Q1 Q2 Q3 Q4 2016 TOTAL Keffi 17 550,000.00 510,000.00 811,377.00 8,113,777.00 9,985,154.00 Nasarawa Eggon 36 750,000.00 1,080,000.00 1,718,212.00 5,266,424.00 Lafia 57 900,000.00 1,710,000.00 272,050.00 2,720,502.00 5,602,552.00 Obi 30 1,431,843.00 4,600,055.00 Awe 24 500,000.00 720,000.00 1,145,474.00 3,510,948.00 Keana 21 630,000.00 1,002,290.00 3,134,580.00

Amount Earned by all health facilities in Nasarawa State

Coverage’s of key indicators - Nasarawa State Averages

HFs Quality scores Quarter I, II, III and IV 2016

Coverage per Service – CPA ( 2016)

New outpatient consultation by a Doctor

Major Surgeries Hospitals

Comparative analysis between GH and PHC - ANC Standard visits

Comparative analysis between GH and PHC – Institutional Deliveries

Quality scores by health facility CPA – Quarter I, II, III and IV2016

Coverage per Service – CPA ( 2016)

Nasarawa State PBF and DFF Health Centers: OPD Coverage

Nasarawa PBF and DFF Health Centers: Normal Deliveries Coverage

Nasarawa PBF and DFF Health Centres: Complete vaccination Coverage

Nasarawa PBF and DFF Health Centers: Family Planning Visits (Pills and Injectable) Coverage

NSHIP MISSION AIDE MEMOIRE FINDINGS 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 in HDRF 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

Challenges to Health system and RBF implementation in Nasarawa State Weak supervision of health facilities by LGA PHCD, SPHCDA and HMB Weak financial management capacity at health facilities. Weak supervisory support in implementation of strategies in business plans by supervisors. Security challenges affecting some wards in the State especially in Doma and Nasarawa LGAs. Weak support of HFs for Business plan development and Financial Management by LGA PHCD and its late submission. Inadequate financial support to SPHCDA and HMB from DLI resources to finance supervision activities Over invoicing by Health Facilities

NEXT STEPS: Capacity Building: Training and certification of LGA and HMB Supervisors on Management, ISS and Quality assessments and use of ICT tools; Training and mentorship of Hospitals and PHC Managers on health facility Management ; Training on Long Acting Reversible Contraceptive; BMJ Clinical Guidelines Intervention and Training of facilitators and Health workers;

RECOMMENDATIONS There is need for the PHC departments and HMB to strengthen their supervisory support to health facilities Capacity building of the PHC department and HMB teams and health facilities managers to improve their managerial and supervisory capacity. Capacity building of Health Facilities Managers to improve their managerial and technical competencies. SPHCDA /HMB should improve on staff discipline and attitude to work. Improvement of security surveillance at community level and on the roads by the Chief Security Officers. Allocation of DLI resources to support supervisory activities of SPHCDA, HMB and LGA PHCD. Health facilities to continuously improve the quality of care

THANK YOU!