Performance-Based Financing Improves Quality of Health Services in Nigeria

    © Olufunke Modupe Olufon / World Bank

    Despite significant health sector investments in recent years, Nigeria has made slow progress in improving its health indices. According to the Nigerian National Primary Healthcare Development agency, a large number of women from low-income households in Adamawa, Nasarawa and Ondo states, do not use health facilities and the chances of giving birth with skilled help can be as low as one in seven.

    The Nigeria State Health Investment Project (NSHIP) aims to change that. Designed by the country’s leading healthcare institutions, and support from the World Bank, NSHIP delivers a results-based approach to improve quantity and quality of health services.

    “Health centers started to receive funds directly based on the quantity of essential services they delivered and the improved quality of care,” said Ayodeji Odutolu, World Bank team leader for the project. “This encouraged health centers to focus on delivering results, and the new funds enabled them to improve their services.”

    Currently being implemented in Adamawa, Nasarawa and Ondo states, the project supports the government’s goal to increase the delivery and use of high impact maternal and child health interventions. For example, the building that houses Karu Health Center in Nasarawa State has been rehabilitated, and trained nurses are now on hand to vaccinate more than 50 infants daily.

    “In the past, the mothers and babies sat outside under a tree to receive immunization, but now we have been able to reconstruct the infant welfare clinic building where there is better comfort than under the sun,” said Sade Adebayo, community health officer at Karu Health Center. “Utilization of the health center has increased.”

    The performance-based financing (PBF) approach has also motivated health worker performance.

    “Health facilities now enjoy semi-autonomy with their own bank accounts,” Odutolu said. “They procure drugs from certified distributors and use 50% of their performance bonuses to maintain facilities while 50% is for incentives to health workers.” 

    The improved quality of care has led to more patients using health centers supported by NSHIP. On the advice of a friend who had delivered her baby at Karu, Saadatu Adamu decided to visit the health center.

    “My friend had a good experience and said positive things about the care she was provided at the facility, so I have been coming for my antenatal, which has been very good,” she said.

    More people are also visiting the Masaka Primary Health Center in Nasarawa, which provides free vaccinations against vaccine-preventable diseases for children aged 0 to 12 months, in-line with the national schedule for immunizations. Other services provided include antenatal, delivery and postnatal care, HIV counselling and testing, diagnosis and treatment of malaria, infant welfare clinic for growth monitoring and nutrition of babies.

    “Through PBF intervention, we have been able to ensure that we have the needed staff to work in critical service areas within the health center,” said Hannah David, nursing sister in charge of Masaka Health Center. “For example, we can and have used in the past, part of our performance bonus to hire dearly needed laboratory staff and midwives. We have expanded our male and female wards and are currently in the process of constructing a maternity wing with the help of the community.”

    Source: World Bank

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