Project to change how Nigeria pays for health care ends soon

A project making the case to modify how health is financed in Nigeria is expected to end in six months.

The Nigeria State Health Program Investment Project (NSHIP), funded by the World Bank, is the first to have used “performance-based financing” on a large scale—“and a lot of lessons have been learnt,” according to Binta Ismail, national project cooperation for NSHIP.

It is looking at another form of health financing, we call it output based financing. In Nigeria, we do a lot of input-based financing where a lot of decisions are taken at the higher level for the lower level. But this is like turning it around, having a bottom-up approach to decision making and decision-making.”

The project spans six states in the northeast, alongside Ondo and Nasarawa, reaching 27 million people across more than 2,000 primary and secondary health facilities in 101 local government areas.

Its aim is to increase the delivery and use of high impact maternal and child health interventions and improve quality of care at selected health facilities in the participating states.

Mirrored in the Basic Health Care Provision Fund, NSHIP funds go to autonomous facilities “based on performance measured by the quality and quantity of services provided,” explained Ismail.

“They utilise the funds without much interference, and it is co-managed by the facility and community to ensure the facility increases its services around quantity and quality.”

Among its target by 2020 is to ensure 2.5m children aged 12-23 months old across the eight states get three doses of pentavalent vaccine. So far, that number stood at 1.9 million last year, compared with a baseline of around 270,000 in 2008.

Another target is to ensure 700,000 deliveries are attended by skilled health personnel; currently, the number of such deliveries is 620,000 from last December, compared with a baseline of nearly 77,000 in 2010.

Ismail said the impact of the $150 million project has been visible.

“There have been independent surveys going on. If you compare the outcomes of these surveys with NSHIP states and non-NSHIP, or even look at the trend of analysis from the baseline to where they are in the implementation of the project, you will visible increase around the indicators that the project is working on,” she said.

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