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National Primary Health Care Development Agency (NPHCDA)

Nigeria State Health Investment Project (NSHIP)

NASARAWA State RBF-TA TECHNICAL SUPPORT UNIT

Service Contract 7730.

__________________________________________________

ACTIVITY REPORT FOR THE FirstQUARTER 2016

(January to March)

_____________________________________________________________

By:

Mr. Eubert Vushoma

Mrs. Christine Mukantwali

Reviewed by: Dr. Joseph Shu

Executive summary

Table of Contents

Executive summaryiList of figures and tablesvList of abbreviationsviiIntroduction11Managerial activities of the technical assistance21.1Quality counter verification21.2Financial management training31.3Detailed Implementation Plan development31.4Disbursement Linked Indicators (DLI) 201541.5Nasarawa State RBF technical working group meeting41.6LGA Steering Committee Meetings51.6.1Post steering committee meeting51.7State Steering committee meeting51.8Write shop51.9Evaluation of the LGAs61.10Quantity verification62Analysis of performance of health facilities and services within the project area122.1Quantity indicators of health facilities122.1.1Evolution of overall MPA indicators for the state: January 2015 to December 2015122.2Evolution of overall CPA indicators: January 2015 to December 2015182.3Comparative analysis between General Hospitals and Primary Health Centres213Quality indicators of health facilities243.1Evolution of the technical quality in health facilities implementing MPA243.2Evolution of the technical quality in health facilities implementing CPA254Evolution of payment of subsidies275Health facility performance by LGA315.1Akwanga LGA315.2Doma LGA335.3Karu LGA345.4Kokona LGA375.5Nasarawa LGA395.6Toto LGA415.7Wamba LGA426Challenges457Conclusion468Recommendations479Planned activities for next quarter4810Annex50

List of figures, tablesand annexures

Figure 1: Volume of service and rejection rate - MPA7

Figure 2: Volume of service and rejection rate - CPA8

Figure 3: Percent concordance between claimed and validated MPA8

Figure 4: Percent discordance between claimed and validated CPA9

Figure 5: Coverage per Service MPA (Quarter 1 to Quarter 4 2015)12

Figure 6: Coverages of key indicators - Nasarawa State Averages13

Figure 7: New outpatient consultation Coverages by LGA MPA (PBF)14

Figure 8: Institutional Deliveries Coverage by LGA - MPA (PBF)15

Figure 9: Immunization Coverage by LGA MPA (PBF)16

Figure 10: Family Planning Coverages by LGA MPA (PBF)16

Figure 11: ANC Standard visits (2-4) Coverage - MPA (PBF)17

Figure 12: Coverage per Service CPA (Quarter 1 to Quarter 4 2015)18

Figure 13: Coverages for key services CPA19

Figure 14: New outpatient consultation by a Doctor CPA (PBF)19

Figure 15: Institutional Deliveries Coverage by GH - CPA (PBF)20

Figure 16: ANC standard visit (2-4) coverage by GH CPA (PBF)20

Figure 17: Family Planning coverage by GH CPA (PBF)21

Figure 18: Comparative analysis between GH and PHC - ANC Standard visits22

Figure 19: Comparative analysis between GH and PHC Institutional Deliveries22

Figure 20: Comparative analysis between GH and PHC New and existing users of modern FP methods22

Figure 21: Quality scores Quarter I, II, III and IV 201524

Figure 22: Nasarawa State Technical Quality by Service - PHCs24

Figure 23: Quality scores by health facility CPA Quarter I, II, III and IV 201525

Figure 24: Nasarawa State Technical Quality by Domain General Hospitals26

Figure 25: Amount Earned by all health facilities in Nasarawa State (Q1 to Q4: 2015)27

Figure 26: Amount Earned by LGA QI, QII and QII 2015 (PBF) - MPA27

Figure 27: Amount Earned by LGA QI, QII and QII 2015 (PBF) - CPA28

Figure 28: Percent of earnings by service/Indicator MPA29

Figure 29: Percent of earnings by service/Indicator - CPA30

Figure 30: Coverage New outpatient consultation Akwanga LGA31

Figure 31: Completely vaccinated Child Akwanga LGA31

Figure 32: Coverage ANC standard visit (2-4) Akwanga31

Figure 33: Coverage Normal Deliveries Akwanga LGA32

Figure 34: Coverage Family Planning (new and existing users) Akwanga LGA32

Figure 35: Coverage new outpatient consultation Doma LGA33

Figure 36: Coverage - Completely vaccinated children33

Figure 37: Coverage - ANC standard visits (2-4) Doma LGA33

Figure 38: Coverage - Normal deliveries Doma LGA34

Figure 39: Coverage - Family planning (new and existing users) Doma LGA34

Figure 40: Coverage - New outpatient consultation Karu LGA34

Figure 41: Coverage - Completely vaccinated Child Karu LGA35

Figure 42: Coverage - ANC standard visit (2-4) Karu LGA35

Figure 43: Coverage - Normal delivery Karu LGA36

Figure 44: Family Planning methods (total of new and existing users) Karu LGA36

Figure 45: New outpatient consultation Kokona37

Figure 46: Completely vaccinated Child Kokona37

Figure 47: ANC standard visit (2-4) Kokona37

Figure 48: Normal deliveries Kokona38

Figure 49: FP: total of new and existing users of modern FP methods Kokona38

Figure 50: New outpatient consultation Nasarawa39

Figure 51: Completely vaccinated Child Nasarawa LGA39

Figure 52: ANC standard visit (2-4) Nasarawa LGA40

Figure 53: Normal deliveries Nasarawa LGA40

Figure 54: FP: total of new and existing users of modern FP methods Nasarawa LGA40

Figure 55: New outpatient consultation Toto LGA41

Figure 56: Completely vaccinated Child Toto LGA41

Figure 57: ANC standard visit (2-4) Toto LGA41

Figure 58: Normal delivery Toto LGA42

Figure 59: FP: total of new and existing users of modern FP methods Toto LGA42

Figure 60: New outpatient consultation Wamba LGA42

Figure 61: Completely vaccinated Child Wamba LGA43

Figure 62: ANC standard visit (2-4) Wamba LGA43

Figure 63: Normal delivery Wamba LGA43

Figure 64: FP: total of new and existing users of modern FP methods Wamba LGA44

Table 1: LGA Evaluation results and bonus due6

Annex 1: Formula for monthly target calculation - MPA52

Annex 2: Demand Side Financing (DSF) list of activities 201653

Annex 3: List of contracted CBOS for CCSS54

List of abbreviations

5

ANCAnte Natal Care

ARMAnnual Review Meeting

CBOCommunity Based Organisation

CBTCommunity Based Targeting

CCSsCommunity Client Satisfaction Survey

CPAComplementary Package of Activities

CSCaesarean Section

CSOCivil Society Organisation

DFFDecentralised Facility Financing

DLIDisbursement Linked Indicators

DRF Drug Revolving Fund

FP Family Planning

HMBHospital Management Board

HMISHealth Management Information System

IUCDIntrauterine Contraceptive Device

LGA Local Government Area

M & EMonitoring and Evaluation Officer

MDGs Millennium Development Goals

MPAMinimum Package of Activities

MSMedical Superintendent

NGONon-Governmental Organisations

NHISNational Health Information System

NPHCDANasarawa State Primary Health Care Development Agency

NSHIPNigerian State Health Investment Project

NTLNational Team Leader

OICOfficer in Charge

OPDOut Patient Department

OPMOxford Policy Management

PBF Performance Based Financing

PCProject Coordinator

PFMUProject Finance Management Unit

PHCPrimary Health Care

PIT Provider Initiated Testing

PIU Project Implementation Unit

PMTCTPrevention of Mother to Child Transmission

RBF TAResults Based Financing Technical Assistance

SMoHState Ministry of Health

SPHCDAState Primary Health Care Development Agency

STDSexually Transmitted Disease

VCTVoluntary Counselling and Testing

WDCWard Development Committee

Introduction

The Nigerian government is currently implementing a five-year Nigerian State Health Investment Project (NSHIP) in three States, Ondo, Nasarawa and Adamawa since 2011 with financing from the World Bank. The objective of NSHIP is to strengthen service delivery at the health facility level and institutional performance at the Federal, State and LGA levels. NSHIP aims at increasing the efficiency, effectiveness, quality and equity of the services offered to the population. In order to fully implement the program in, NSHIP contracted the Results Based Financing Technical Assistance to provide consultancy services to the project using multi country experiences of its team members. This report highlights the activities carried out by the RBF TA, analysis of operational, financial and quality data for Nasarawa State and provide recommendations to various stakeholders for improvement of operations in the State during the period January to March 2016. The activities of the RBF TA include the design/redesign and definition of operational procedures for the Results Based Financing components (the DLIs; DFF and PBF) and build institutional capacity of the NPHCDA/SPHCDA to carry out purchasing, verification and oversight functions, and assist the States and the LGAs to make operational its DLIs/scorecards through an advisory function. The following are key activities by the State NSHIP project Implementation Unit (PIU) and RBFTA in the quarter under review.

NSHIP PIU meetings

Nasarawa State Primary Health Care Development Agency (NAPHDA) Website

Finalisation of the