1. NASARAWA STATE GOVERNMENT NIGERIA STATE HEALTH INVESTMENT PROJECT (NSHIP) PROJECT PERFORMANCE REVIEW JANUARY TO JUNE 2015

2. PRESENTATION OUTLINE  State background  Introduction  State performance review by LGA  Financial Matters and burn rate  Key achievements for Q1 and Q2 2015  Completed activities for Q1 and Q2 2015  Planned activities for Q3 and Q4 2015  Strategies for improvement of performance

3. BACKGROUND  State Population = 2,469,175  LGAs =13  Political Wards =147  Public Health Facilities :  Tertiary HF = 2  Secondary HF = 18 PBF Secondary HFs = 8 DFF Secondary HFs = 6  Public PHCs in the state = 728 PBF HCs = 86  Subcontracted health facilities = 97 DFF HCs = 73  Private HFs = 277+

4. NSHIP project objective: 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

5. NSHIP development indicators:  Proportion and number of 12-23 month old children fully immunized;  Proportion and number of births attended by skilled health providers at health facility;  Average of Health Facility Quality of Care Score;  Number of outpatient visits by children under five; and  Direct Project Beneficiaries (number), of which are female (%).

6. Update on State - NSHIP key activities January to June 2015  Finalisation and defence of 2014 Disbursement Linked Indicators (DLI) report  2014 DLIs assessment and payment of State and LGAs DLI bonuses  Community Based Targeting (CBT) training of enumerators, poverty mapping data collection and entry  Monthly quantity verifications  Periodic Supervisions and Quarterly quality assessment by the PHC departments and HMB  Financial management clinic in Abuja  Procurement clinic in Abuja

7. Activities cont …..  Payment of balance of investment financing to both DFF and PBF HFs  Q4 - 2014, Q1 and Q2 – 2015 LGA steering committee meetings and validation of invoices  LGA PHC Departments quarterly evaluations  Payment of Q4 2014, Q1 and Q2 2015 bonus/subsidies to both PBF and DFF HFs, LGA PHC Depts. and the HMB  Quality and quantity counter verification  Engagement of verifiers and project support staff

8. Activities cont ….  Monthly data collection on DFF health facilities  HMB extended team meetings and assessment of General Hospitals  Coaching and mentoring of health facilities and PHC departments on quality service delivery and business plan development  Capacity building of the PIU and PFMU personnel on PBF, flexible accounting, M & E and Financial management  Hosted and facilitated the National PBF course in Akwanga  Procurement of State project vehicles

9. Activities cont …..  Recruitment and training of Community based Organisations  Participated in the project Annual Review Meeting in Abuja  Management of performance data on the PBF portal  Participated in State coordination meetings (Data harmonisation, Monitoring and Evaluation working group, etc)  State RBF technical working group meeting  State RBF Steering committee meeting

10. State performance review MPA 20 indicators CPA 22 indicators

11. Coverage - MPA indicators

12. OPD Coverage PBF and DFF

13. OPD Coverage by LGA – MPA (PBF) – First Biannual (2015)

14. Institutional Deliveries PBF and DFF

15. Institutional Deliveries Coverage by LGA - MPA (PBF) – First Biannual (2015)

16. Immunization Coverage PBF and DFF

17. Immunization Coverage by LGA – MPA (PBF)

18. Family Planning PBF and DFF

19. FP Coverage by LGA – MPA (PBF)

20. Coverage - CPA Indicators

21. New outpatient consultation by a Doctor – CPA (PBF)

22. Technical Quality of Care by LGA

23. Technical Quality of Care by General Hospital

24. Quality score by Service – MPA

25. Quality score by Service – CPA

26. Finance

27. Payments to health facilities 40% increase in Earnings

28. Earnings per capita/ LGA (Q2 adjusted annually)

29. Percent of earnings by service/Indicator - MPA

30. Percent concordance between claimed and validated – MPA (Quarter 2 – 2015)

31. Percent concordance between claimed and validated – CPA (Quarter 2 – 2015)

32. HMIS Reporting by LGA

33. LGA Performance Analysis – QII 2015 LGA performance analysis in terms of the following variables (presented above)  HMIS (reporting rate)  Performance Management (LGA performance Framework)  Earnings (per capita)  Quality (Technical quality of care)  Quantity (overall coverage for all the services combined)  Rejected Claims (% concordance between claimed and validated)

34. Overall LGA Performance Q2 2015 LGAHMIS Performance ManagementEarningsQualityQuantity Rejected ClaimsAverageRanking Akwanga1151512.3333331 Wamba5112152.52 Kokona3536223.53 Doma21737444 Karu7125374.1666675 Toto4564665.1666676 Nasarawa7747435.3333337

35. Key achievements  Migration from manual to electronic accounting system at PFMU (flexible accounting)  Improvement in the quality of care and general management of health facilities  Improvement in earnings by health facilities  100% DLI achievements for 2014  Use of DLI funds to strengthen health care delivery in the State  Over 94% score in SPHCDA assessment for the first half of 2015

36. Key achievements Cont …….  Successfully completed the quantity and quality counter verification in Wamba and Karu LGAs. Lessons derived influencing project implementation  Successfully completed household mapping in Wamba for DSF  Community involvement in health management  Dissemination of project information in prints and electronic media  Improvement in HMIS reporting (PBF and DFF to a lesser extent)  Infrastructural improvements at the health facilities (both PBF and DFF)

37. Planned Activities for Q3 and 4  PIU Meetings  Conduct of Integrated Supportive Supervision to LGA PHC Departments (both PBF and DFF)  Conduct of quantity Data Verification of PBF HFs and data entry  Collection of last quarter service data from DFF LGAs PHC department  Conduct of LGA PHC Departments Performance Evaluation  External training on Project management, Procurement etc  Technical support to LGAs PHC dept. for Health facilities quarterly quality assessment  Participate in HMB quarterly quality assessment of General Hospitals  Capacity building of HFs OICS, Waste mgt. officers on Waste management

38. Planned Activities for Q3 and 4  Participate in LGAs steering Committee meetings of the PBF LGAs  Conduct of LGA PHC performance frame work assessment  Community PBF and Health Insurance Study Tour to Rwanda  Payment of quarterly bonuses to PBF Health Facilities and subsidies to DFF HFs  Payment of supervision subsidies to HMB  Urban PBF Study Tour to Cameroon  Scale up training to Sub-contracted Health Facilities  Sponsor key policy makers to RBF International training in Mombasa, Kenya  Financial Management training of all Health Facilities Managers and Finance staff  NSHIP Stakeholders meeting  NSHIP leadership Retreat

39. Planned Activities for Q3 and 4 contd.  Training of staff from additional/subcontracted DFF and PBF Health Facilities  Participate in quarterly review meetings  PBF Internship recruitment and training  Organize TWG Meeting  Participate in State Steering Committee Meeting  Documentation,production and dissemination of information  Preparatory processes for 2015 DLIs report  TOT training of 15 members on PBF extended team

40. Strategies to improve performance  Subcontracting of additional health facilities in the respective wards (PBF)  Contracting additional DFF facilities  Strengthening community dialogues  Strengthening the HMIS through capacity building, partnership and collaboration with SMoH to produce data tools and manage same.  Improving data management capability at all levels  Speedy authorization of activities and payments

41. Strategies to improve performance Cont ….  Speedy payments through the electronic platform  Strengthen financial management through training and coaching  Implementation capacity strengthening through trainings, coaching and mentoring  Renovation and upgrading of the PIU/SPHCDA office to provide conducive working environment  Engagement/ Deployment of more staff to the PIU and capacity building of the staff.

42. Thank you for listening