By Ndidi Chukwu
A World Bank health system financed project, Nigeria State Health Investment Project, (NSHIP) adopted by the National Primary Health Care Development Agency (NPHCDA) in 2011 will be expanded to reach key maternal and child health interventions in Nigeria. The Executive Director of the NPHCDA Dr Ado Muhammed said NSHIP so far has yielded a threefold increase in performance of healthcare facilities at the pilot states.
His comment came as the agency convened a meeting of the 2014 Annual Review of the project in Abuja. He said what the project has done is a new approach to service delivery in which the approach is to shift from input to output as they are now looking at results in terms of what the funds has resulted to.
NSHIP, piloted in three states of Adamawa, Nasarawa and Ondo tries to provide managerial autonomy to health facilities whilst strengthening accountability mechanism at the LGA primary Health Care authority and State Primary Healthcare Development Agencies through a collective package of institutional and operational level results based approaches.
This is with the aim to “increase the delivery of high impact maternal and child health interventions and to improve the quality of care at the selected health facilities” said Ado
“The focus is on performance as we look at how many lives have been saved, what disease burden has been reduced, how many immunisation sessions are taking place, the outcome in terms of maternal mortality reduction, and how many women have attended antennal care.
“The essence of today’s meeting to carefully review how far we have gone at delivery in terms of performance and to see how we can further improve on the programme.”
According to him, “For these three years we have seen improvements in service delivery as more women now go for antenatal care, there are skill birth attendants during delivery, more children are been immunized and we have seen a threefold improvement in terms of
Ado noted that service delivery at the implementing states have improved adding that it is a success story that he envisage at the end of the day, the states will take-over the programme as they hope to entrench it within the system so that even by the time project is over, those good practices will continue in the system
Earlier, Dr Nnenna Ihebuzor, who is the director of Primary Health Care Systems Development at NPHCDA, explained that the difference between this project and others is that its financing is based on performance as facilities must report on agreed targets. She said that for implementing health facilities, “If you agree that you are going to increase your coverage by a certain per cent, we will then check at the end and you will get an incentive for this in terms of bonus for the facility and it will be given some financial autonomy to use that and improve its services.”
“This autonomy helps improve service delivery because in a normal situation, the facility will have to wait for a long time for approval either from the state or the local government before you can do simple improvements that will change service delivery,” he added. Dr Ihebuzor explained that when you increase the utilization of healthcare services with increasing the quality, you may actually be doing harm.
She said for instance, “we are checking at the facilities if they have good infrastructure, are they clean, are they sterilizing their instrument, do they have their drugs available all the time, do they have equipment that will help them run the facility very well, are they catering for the health needs of indigent population, and if they are running an antenatal or maternity clinic. These are the small indices that we use to measure quality.