Nigeria State Health Investment Project: Driving Health System Improvements for Mothers and Newborns

Presenter: Nnenna Ihebuzor, National Primary Health Care Development Agency

Background: Although Nigeria has relatively high levels of health spending compared to other African countries, the quality of health services is suboptimal and coverage of effective, low-cost interventions for maternal and child health is low and often do not reach the poor; there is lack of incentives for achieving results and poor accountability for results.

Methodology: Nigeria needs to dramatically strengthen service delivery and improve health outcomes if it is to make significant progress in achieving the MDGs and the post-MDG agenda. It is in this context that the Nigeria State Health Investment Project (NSHIP), using a Results-Based Financing (RBF) approach, seeks to demonstrate a positive impact on health system performance, provider behaviour and quality of care at selected health facilities in participating states. NSHIP benefits the entire population of project states, specifically women of child-bearing age, Under-5 children including newborns. At health facility level, NSHIP provides cash rewards for the quantity and quality of services provided based on a defined package of care across the continuum for RMNCH, HIV/AIDS. Performance is verified using robust and independent methods. Facilities are given considerable autonomy in use of these earned funds for operational costs, maintenance and repair, drugs and consumables, outreach services and performance bonus for health workers. Given Nigeria’s decentralization, NSHIP also tests disbursement linked indicators (DLIs) at local government and state levels against which funds are disbursed for strengthening supervision, improved HMIS data reporting and use etc.

Results: The NSHIP with about US$1/capita/year has resulted in at least 15% increase in antenatal visits and institutional delivery with skilled attendants and significant increase in quality scores.

Conclusion: Providing autonomy, cash incentives and a result-focus can significantly improve the quality and coverage of maternal and newborn health care services.