Nigeria State Health Investment Project (NSHIP) Nasarawa State Technical working group meeting: 11 January, 2017

Presentation outline Project objectives and development indicators Mid term review highlights October 2017 health facility assessment July to September 2017 performance data Results Based Financing (RBF) Demand Side Financing (DSF) Upcoming activities Recruitment of CBOs for CCSS Quality counter verification Technical discussion

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 are female.

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 are female.

Mid term review highlights Financial sustainability PBF Lite will be applied going forward in NSHIP States States need to enter in to discussions immediately around counter-part funding by the government for sustainability Reduction in number of international/external trainings for NSHIP States. Reduction in SPHCDA PIU operating costs will be enforced Disbursement linked indicator to be removed from project design in NSHIP states Subcontracted facilities will remain suspended Improved financial accountability to reduce ineligible expenditure at State level No statistical differences in performance of PBF and DFF

Mid term review highlights Counter verification Frequency CCSS (quantity) and quality counter verification will be conducted quarterly Coverage 100% of health facilities will be counter-verified quarterly

Mid term review highlights Claimed vs. verified error margins If error margin is between +/- 5 and 10%. First offence: retention of 20% of PBF earnings (from verified data) for that indicator for the month under review PLUS warning in writing to the health facility RBF committee with copy to the LGA chairman and SPHCDA Second offence: retention of 50% of PBF earnings (from verified data) for that indicator for the month under review PLUS warning in writing to the health facility RBF committee with copy to the LGA chairman and SPHCDA Third offence: stop purchase of that indicator for the month under review If error margin exceeds +/- 10% First offence: retention of 50% of PBF earnings (from verified data) for that indicator for the month under review PLUS warning in writing to the health facility RBF committee with copy to the LGA chairman and SPHCDA Second offence: stop purchase of that indicator for the month under review

Mid term review highlights No payment will be made until counter-verification processes are completed and systems put in place Payment of subsides will be quantity conditional on quality Payment of subsides

Mid term review highlights Ward Development Committees (WDC) Contracting 1 Track drop out for immunization, TB, ANC, HIV 2 Bringing indigent clients to the HF

Mid term review highlights Supervision funds to LGA PHCD should be used for both NSHIP and non- NSHIP facilities Individual performance bonus are to be shared among LGA PHC Coordinator and the 8 certified supervisors per LGA 10% of performance framework funds are to be used for operational costs at the LGA PHCD Up to 20% of performance framework funds can be used for individual performance bonuses The remaining 70% should be used to cover supervisory costs to both NSHIP and non-NSHIP facilities GA PHCD will receive $305 per PBF HF in LGAs that have a verified NSHIP to non-NSHIP HF ratio of less than 1:4 LGA PHCD will receive $350 per PBF HF in LGAs that have a verified NSHIP to non-NSHIP HF ratio of 1:4 or greater In exceptional circumstances, where an LGA has a verified NSHIP to non-NSHIP HF ratio of significanly more than 1:4, the funding allocation can be reviewed on a case by case basis Reviewed PF for LGA PHCD will include evidence of supervision in non-NSHIP facilities Supervision/Management

Mid term review highlights Low Supervisory Capacity 1 Assign facilities to specific supervisors 2 Assess LGA PHC based on HF performance Individual Performance Evaluation for LGA PHC Supervisors Percentage of performance bonus (up to 20%*) to be used as individual incentives at the LGA PHC level Application of LGA PHC and HMB indice tools

Mid term review highlights Managerial capacity Need-based managerial trainings Regular, data-driven coaching and mentoring by LGA PHCD, verifiers and SPHCDA Review of individual performance frameworks in line with TORs Health facilities to have client feedback boxes to monitor staff behaviour and quality of service

Mid term review highlights Contract Staff Development of protocol for contracting of staff Designated finance and record officer from existing PHC gov. staff Limitations on recruitment of non-technical staff Range of competitive salary that is sustainable Negotiate inclusion of NGO training HRH in all HF activities

Mid term review highlights HF Contracts To be reviewed every 6 months, in line with BP implementation If after 6 months, HF has implemented less than 50% average of BP activities, HF will receive a warning If the consecutive BP cycle is also less than 50% implementation (on average across the next 6 months), the contract will not be renewed

October 2017 health facility assessment

October 2017 health facility assessment HF Contracts Total of 60 health facilities reassessed for continuity of PBF contract 19 health facility contracts will not be renewed for the following reasons Failure to adhere to NSHIP guidelines No enabling infrastructure to operate as health facilities (some should actually be declared closed by the SPHCDA) No staff to manage the facilities Community conflicts affecting health delivery

July to September 2017 Performance data Results Based Financing (RBF)

Performance data LGA PHC evaluation

Performance data Status of disbursements for the quarter ending 30 September 2017 (Total = NGN 361,705,813.56)

At least 40% of the data were rejected by verifiers Performance data At least 40% of the data were rejected by verifiers

Rejection rate by indicator/service – MPA Performance data Rejection rate by indicator/service – MPA

Rejection rate by indicator/service – CPA Performance data Rejection rate by indicator/service – CPA

Client patronage by type of facility Performance data Client patronage by type of facility Average clients per provider/Number of HF by provider Overall volume of service by group (GH, Public and Private PHC) – July to September 2017

Technical quality of care - MPA Performance data Technical quality of care - MPA

Technical quality of care by Domain - MPA Performance data Technical quality of care by Domain - MPA

Technical quality of care by Domain - CPA Performance data Technical quality of care by Domain - CPA

Subsidies paid by type of health facility – July to September 2017 Performance data Subsidies paid by type of health facility – July to September 2017

Demand Side Financing (DSF)

Demand Side financing

Distribution of payments by indicator/service - July to September 2017 Demand Side financing Distribution of payments by indicator/service - July to September 2017

Upcoming activities

Submission of 2018 work plan Quality Counter verification Recruitment of CBOs Literate Able to use android phone Ownership of android phone desirable Quantity counter verification

Technical discussion

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