Measuring Health Policy Development Capacity in Nigeria Allison Goldberg, Ph.D. Candidate Columbia University

Outline of Presentation The Purpose Innovative Methodology Baseline Results What’s Next?

Purpose of the Assessment Provide a baseline assessment of health policies developed at the Federal and State Government levels in Nigeria that can be measured against future policies developed with PATHS2 support Output 1.1 and 2.1 Number of new and revised state and federal policies developed with PATHS2 support that are consistent with the National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard

What Are We Measuring and Why is this Important? The Policy Cycle Agenda Setting Policy Formulation Policy Implementation Policy Evaluation of Effect on Outcomes Feedback Political scientists devoted to public policy issues have used a fairly common heuristic framework to provide a conceptual grounding for public policy analysis. This framework consists of discrete phases associated with the policy process. Some political scientists have identified as many as seven stages, but the convention is 4. Agenda setting: Stage where issues gain ascendancy as they compete for the limited attention of policy-makers. Policy Formation: This is the stage where the the policy itself is defined. Policy Implementation: this is where policy decided up is put into action Policy Evaluation of effect on outcome: this is where questions such as “has the policy worked?” “how can we improve policy implementation” are answered. Anderson, James E. (1972). Public Policy-Making. New York: Praeger Publishing.

Methodological Underpinnings Adaptation of the World Bank and partners’ Performance Measurement Framework (PMF) An international standard for measuring National and State Government performance across a range of areas (e.g. financial, institutional oversight, service delivery) SPARC and ESSPIN (Parallel Projects of DFID) also adapted the PMF to assess the institutional functionality of State bodies (e.g. QA, policy & planning, budgetary accountability) Performance Measurement Framework (June 2005). PEFA Secretariat, World Bank, Washington DC, USA - PEFA includes World Bank, IMF, European Commission, UK, France, Norway, Switzerland and SPA Strategic Partnership with Africa.

Measurement Framework Minimum Quality Standard Clear goals and objectives Clear and actionable implementation plan Feasible budgets Baseline information and research findings and/or national or international policies and guidelines are used to inform the policy development process Consistent with National Strategic Health Development Plan (NSHDP) The views and opinions of local government, civil society and non-governmental sector actors were taken into consideration Policies address the needs of disadvantaged groups, such as women and children, the poor, those living with HIV/AIDS, and others Policies include language that is consistent with the Millennium Development Goals Domain 1 Domain 2

Scoring The Indicators Scoring: Consistent with NSHDP (Domain 2) Policies include language that is consistent with the Millennium Development Goals Atleast six MDGs are explicitly referenced in the policy and some of the goals and/or objectives are aimed at meeting MDG indicators A Atleast half of the MDGs are explicitly referenced in the policy and some of the goals and/or objectives are aimed at meeting MDG indicators B Less than half of the MDGs are explicitly referenced in the policy, but none of the goals and objectives are aimed at meeting MDG indicators C The MDGs are not explicitly referenced in the policy D

Scoring the Domains Scoring: Consistent with NSHDP (Domain 2) B C Policies include language that is consistent with the Millennium Development Goals The views and opinions of local government, civil society and non-governmental sector actors were taken into consideration B Policies address the needs of disadvantaged groups, such as women and children, the poor, those living with HIV/AIDS, and others C Domain II Score

Complete Scoring Matrix

The Policies National Policies (n=16) Revised National Health Policy National Anti-Malarial Treatment Policy National Policy on Population and Sustainable Development Nigeria National Medical Laboratory Services Policy National Policy on Infant & Young Children Feeding in Nigeria National Workplace Policy on HIV/AIDS National Policy on Integrated Disease Surveillance & Response National Policy on Food & Nutrition in Nigeria National Blood Policy National Human Resource Policy for Health National Child Health Policy National Health Financing Policy 2006 Health Promotion Policy for Nigeria Maternal, Newborn, & Child Health in Nigeria National Policy on HIV/AIDS National Health Equipment Policy for Nigeria State Policies (n=3): Enugu, Jigawa, & Kano State Health Policies

Overall Results A B C D Half of the national policies scored a B while the other half scored a C+ Two out of three state policies* earned a score of a D+ Only the State Health Policies of Jigawa, Enugu, and Kano were included the baseline assessment. Few state specific health policies were reviewed since many states follow national policy guidelines

National Policies Disaggregated by Domain The modal composite scores for the MQS and NSHPD domains were a C+ and an A respectively The policies performed much better in Domain 2: Consistency with the NSHPD

More Results on the National Policy Analyses MQS (Domain 1) All policies assessed were found to have clear goals and objectives No policies included a feasible budget Only two policies* contained a clear and actionable implementation plan Consistency with the NSHPD (Domain 2) The majority of policies (9) clearly described the process by which opinions and views of local government, civil society, NGO, and others were included All but 2 policies explicitly referenced the need of disadvantaged groups (e.g. women, children, people living with HIV/AIDS) Benchmarks on the use of language consistent with achieving the MDGs were less commonly met than the other indicators assessed 4 policies, including the Child Health Policy and the National Policy on HIV/AIDS, referenced less than half of the MDGs and omitted MDG indicators from the goals and objectives *National Medical Laboratory Services Policy and the National Human Resource Policy for Health

State Policies Disaggregated by Domain None of the include actionable implementation plans, budgets, and indications that the policies were evidence-based. Only one policy specified clear objectives 2 policies referenced the need of disadvantage groups None of the policies referenced the MDGs

What’s Next? Applying same tool in the next 4 months to compare to baseline Receiving HS 20/20 project funding to link the policy formulation, policy implementation, and policy evaluation stages Agenda Setting Policy Formulation Policy Implementation Policy Evaluation of Effect on Outcomes Feedback Anderson, James E. (1972). Public Policy-Making. New York: Praeger Publishing.

www.abtassociates.com/HSRsymposium Thank you