L-R , Minister of Health Professor Isaac Adewole ; Vice President Yemi Osinbajo present an award of Best Improved State to FCT Minister , Mohammad Bello while Chairmman , Thisday Newspapers , Prince Nduka Obaigbena looks with interest

Thisday Health Summit

Martins Ifijeh reports on how the eight states honored at the 3rd THISDAY Healthcare Policy Dialogue distinguished themselves in the provision of basic health services to their people

While the 3rd THISDAY Healthcare Policy Dialogue held last weekend in Abuja focused on addressing issues around provision of healthcare to vulnerable Nigerians, it also provided an opportunity for states that have distinguished themselves in healthcare services to be honored.

It was a time for pump and cheer, as eight states emerged best in different areas of primary healthcare services to their people using the Saving One Million Lives Performance for Results (SOMLPforR) programme put in place by the federal government.

Under the programme, the federal government, had last year, disbursed $1.5 million to each state of the federation to support them in the improvement of health outcomes in their states with key focus on: provision of quality healthcare in primary health facilities, vaccination coverage among children; contraceptive prevalence rate; skilled birth attendance; HIV counseling/testing among women attending antenatal care; and use of insecticide treated nets by under five children, among others.

But as some states have continued to struggle towards making impact with the funds, those who have hit the ground running are already making impact in their respective states with independent/non-partisan verifiable performance index showing they are moving one step at a time towards helping the country achieve Universal Health Coverage (UHC).

States honored for distinguishing themselves are Zamfara (North-west), Adamawa (North-east), Federal Capital Territory (North-central) and Cross River (South-south), which were selected as best improved states with overall improvement in key maternal, newborn and child health indicators; Lagos and Anambra won as best performing states on immunisation; while Delta and Kano States emerged states with the most people covered under State Social Health Insurance Agency, with a focus on poor and vulnerable population covered mandatorily with public financing.

The SOMLPforR, according to the Minister of Health, Prof. Isaac Adewole, is a tool that helps Nigeria address the burden of healthcare, especially in rural and hard to reach areas of the country, where mostly, the poor and the vulnerable live.

Adewole said at the Summit that the grant already given to states represents just part of what they will get under the project as they continue to push towards UHC in their various states, adding that the idea was so states do not relax in the provision of healthcare to their people.

He said as states judiciously follow through with the SOMLPforR programme, it will go a long way in moving Nigeria towards “healthcare for all”, a slogan global health bodies believe can solve healthcare challenges across the globe.

Giving details of how the eight states emerged during his presentation at the Summit, the National Programme Manager, SOMLPforR, Dr. Ibrahim Kana said the method of selection followed a painstaking process which then identified eight states in a comprehensive evaluation process carried out by the Federal Ministry of Health.

He said the performance rewards were calculated based on five Disbursement Linked Indicators (DLIs) under the SOMLPforR.

“The first, DLI 1, which is the increasing utilisation (quantity) of high impact reproductive and child health and nutrition interventions, relies on results from SMART surveys (the 2015 SMART Survey is the baseline for this DLI under the SOMLPforR). This survey mainly looks for improvements in six key indicators of maternal & child health, which are; immunisation coverage, bed net use by children under five, vitamin A supplementation, family planning, HIV testing during pregnancy, and use of skilled birth attendance (SBA).

“Results from the 2016 Multiple Indicator Cluster Survey (MICS) were compared against results from the 2015 SMART survey (baseline) in order to determine which states had improved on the above indicators,” Kana said.

He said the performance result shows that more than half of the states did worse in 2016 as compared to 2015 in most indicators, adding that 29 states had a lower modern contraceptive prevalence (CPR) in 2016 as compared to 2015, while 27 states had a lower immunisation coverage with a mean decrease of 6.4 percentage points in 2016.

“Slightly more than half of the states improved on skilled birth attendance and insecticide-treated net (ITN) use, with mean increases in coverages at 1.5 and 3.2 percentage points respectively—this performance is less than ideal according to analysis by the assessors. In the 12 states that improved on overall composite indicator in 2016, most of the improvements came from ITN coverage, followed by prevention of mother-to-child transmission of HIV (PMTCT), and then SBA.”

He explained that on DLI 2, which is the Increasing Quality of High Impact Reproductive and Child Health and Nutrition Interventions, the survey relied on results from the National Health Facility Surveys (the first of which was conducted in 2016) and states were assessed according to the SOML-PforR’s Quality of Care (QoC) Index which has five indicators: clinical competence (adherence to guidelines, accuracy of diagnosis, management of maternal, neonatal complications), availability of drugs and basic equipment, readiness to deliver key SOML services,  quality of supervision, Financial management and quality of HMIS data

“On DLI 3, which is the improving M&E systems and data utilisation (and implementing a performance management system in all states, the Federal Ministry of Health committed to helping state Ministries of Health develop and operate performance management systems with the aim of strengthening accountability mechanisms and fostering evidence-based decision making in health.

Under the SOMLPforR, the implementation of a performance management system is meant to ensure that states remain laser focused on results by linking their actions/interventions directly with measurable outcomes in the shortest possible timeframe.”

He said on DLI 4, which is the Increasing Utilisation and Quality of Reproductive and Child Health and Nutrition Interventions through Private Sector Innovation, the survey looked at how implementation of innovation fund that help address SOML challenges like small grants (up to $100,000) to test or develop new techniques, technologies; larger grants (up to $1 million) to test new approaches to improving the delivery of SOML services; and proposals judged ‘blindly’ by independent panel using explicit criteria.

“On the DLI 5, which is the Increasing Transparency in Management and Budgeting for PHC, the survey looked at transfer of staff at facility level to SPHCDA, and consolidated budget execution report produced and published annually,” he added.

While making his remarks after the presentation of awards to the star states, Vice President Yemi Osinbajo said the THISDAY health initiative had helped in honouring high performing states, adding that with the initiative, more people can now hold states accountable for the funds given to them for the provision of primary healthcare in their various states.

He urged state governments to make good use of  the funds, warning that states which fail to make judicious use of such funds will be denied access to further grants in future.

Arguing that the dialogue platform does not recognise performance on the basis of political affiliation but rather on merit, Osinbajo pointed out that the output of the initiative so far had shown that Nigeria’s healthcare was not only functional but health workers were also trained and motivated.

“With the policy, Nigerian children would no longer suffer from preventable diseases, adding that maternal mortality will be put under control while parents will be helped to engage in effective family planning.

According to the vice president, the initiative will also help Nigeria in achieving universal health coverage which he said included the agenda to save one million lives (SOML) annually, adding that the initiative would also help the country in driving institutional process on primary healthcare.

“This initiative had also provided the platform to reward improvement in primary healthcare provisions and as well served as a useful platform for decision makers through the deployment of measurable indicators.”

The 3rd THISDAY Healthcare Policy Dialogue, which brought together under one roof, the presidency, governors, ministers, state commissioners of health, development partners, healthcare stakeholders, and the public, was co-sponsored by the Federal Ministry of Health and the World Bank Group.