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

2. 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)

3. 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.

4. NSHIP DEVELOPMENT INDICATORS
Proportion and number of 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.

5. 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

6. 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

7. 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

8. 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

9. Activities Gallery

10. Activities Gallery

11. Activities Gallery

12. Activities Gallery

13. Activities Gallery

14. State performance review

15. STATE AND LGA DLI EARNED SO FAR

16. 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
$ $650, $1150, Total amount earned

17. 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

18. 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

19. 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

20. Amount Earned by all health facilities in Nasarawa State

22. Coverage’s of key indicators - Nasarawa State Averages

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

29. Coverage per Service – CPA ( 2016)

30. New outpatient consultation by a Doctor

31. Major Surgeries Hospitals

32. Comparative analysis between GH and PHC - ANC Standard visits

33. Comparative analysis between GH and PHC – Institutional Deliveries

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

35. Coverage per Service – CPA ( 2016)

37. Nasarawa State PBF and DFF Health Centers: OPD Coverage

38. Nasarawa PBF and DFF Health Centers: Normal Deliveries Coverage

39. Nasarawa PBF and DFF Health Centres: Complete vaccination Coverage

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

41. 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

42. 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

43. 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

44. 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;

45. 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

46. THANK YOU!