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

2. 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

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 are female.

5. 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 are female.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. October 2017 health facility assessment

17. 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

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

19. Performance data
LGA PHC evaluation

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

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

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

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

24. 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

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

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

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

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

29. Demand Side Financing (DSF)

30. Demand Side financing

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

32. Upcoming activities

33. 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

34. Technical discussion

35. THANK YOU!