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Ibrahim Ozovehe Yisa, MBBS,MPH, FMCP Overall framework, indicators, and methodologies of tracking HSS in PATHS2.

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Presentation on theme: "Ibrahim Ozovehe Yisa, MBBS,MPH, FMCP Overall framework, indicators, and methodologies of tracking HSS in PATHS2."— Presentation transcript:

1 Ibrahim Ozovehe Yisa, MBBS,MPH, FMCP Overall framework, indicators, and methodologies of tracking HSS in PATHS2

2 Nigeria: Background and context PATHS2 Programme Measuring and tracking progress Logframe Baselines Outline of the Presentation

3 Background & Context (I) State of Nigerian Health System: Poor performance Ranked 187 out of 192 health systems assessed (WHO, 2000) Factors responsible for poor performance are multidimensional, but can be broadly grouped into: Fragmentation of the health system characterized by : Inability of government to provide effective leadership & strategic direction in the health sector poor coordination /linkage between multiple actors, including engagement with the community and the private sector

4 Background & Context (II) Failures of system components characterized by: Decay of health infrastructure Dysfunctional HMIS Dysfunctional & uncoordinated supply of health commodity and distribution system Critically low level of health workforce Inadequate funding

5 1/27/20145 PURPOSE: To improve the planning, financing and delivery of sustainable and replicable pro-poor services for common health problems in up to 6 states POLICY AND PLANNING CAPACITY DEVELOPMENT KNOWLEDGE MANAGEMENT MONITORING AND EVALUATION PARTNERSHIPS AND CO-ORDINATION OPERATIONS RESEARCH Output 1 STEWARDSHIP Output 2 STATE SYSTEMS Output 4 VOICE and ACCOUNTABILITY Output 5 Informed citizens Output 3 SERVICES and SUPPLIES GOAL Nigeria's own resources are efficiently and effectively used to achieve the MDGS

6 1/27/20146

7 PATHS2 M&E Strategy for measuring HSS Covers the health system approach & all five PATHS2 outputs Output 1: Governance (Stewardship): Capability Accountability (PEMR) Responsiveness Output 2: State systems: HF, HRH, HMIS, availability of health commodities & distribution system Output 3: Service Delivery (sustainable, replicable & pro-poor) Availability, utilization, quality of care & level of satisfaction Output 4: Community engagement (CSM) Output 5: Informed citizens (Ask Nig Project) Total of 27 indicators

8 1/27/20148 Baseline survey General Objective: To determine the situation of Health Care Service delivery in PATHS 2 Supported States in Nigeria Specific Objectives: To examine the current status of service availability and use in PHC facilities To examine the status of selected supply- and demand-side health system factors affecting service delivery To update the baseline information for the PATHS 2 logframe for monitoring and evaluating the progress of the programme

9 Study Design & Methodology Nigerian healthcare delivery system is structured into: PHC at LGA level (District), SHC (State level) & Tertiary (Fed) All LGAs in the supported states were included in the survey Availability and use of services at PHC, central focus of the study Sampling frame - List of PHC facilities & catchment areas in an LGA - (does not exist in the Nigerian Statistical Structure) Design Option: Enumeration Areas (EAs) provided by NPC & NBS used as sampling frame and nearest HF captured Two EAs randomly selected from each LGA Sixteen (16) HHs randomly selected from 250 EAs Total of 4000 HHs randomly selected for the study (Sample size)

10 1/27/201410 Baseline survey instruments 1. Household survey (HHS) 2. Facility survey (FS) 3. Policy assessment tool (PA) 4. Federal-level data collection tool (F) 5. State-level data collection tool (ST) 6. LGA-level data collection tool (LGA) 7. Health information & Communication (HC) 9. Qualitative data collection instruments for addressing issues on community engagement

11 PATHS2 27 Logframe Indicators & Baseline Values LevelName of IndicatorBaseline Value Goal: 1Under 5 Mortality Rate157 deaths per 1000 live births Goal: 2Proportion of births attended by skilled health personnel National: 38.9%; Enugu, 65.5%: Jigawa 5.1%; Kaduna, 21.8%; Kano, 12.7% Goal: 3TB Case Detection RateNational: 30.5%; Enugu, 45.5%; Jigawa, 23.3%; Kaduna, 65.9%; Kano, 58.7% Purpose: 1Level of compliance with the MTSS process in the preparation of annual performance based budgeting at federal and state levels National: 10% Purpose: 2Antenatal Care Coverage (4 Visits)National: 44.8%; Urban, 68.8%; Rural, 34.4% Purpose: 3Proportion of 1 Year old children immunized against measles National: 41.4%; Enugu, 53.6%; Jigawa,8.3%; Kaduna, 56.9%; Kano, 17.8% Purpose: 4Percentage of LGAs in PATHS2 Supported states with at least one functioning pro-poor health financing mechanism (safety nets) To be determined Purpose: 5Number of states implementing systems strengthening approaches to increase access to quality services for women and the poorest 0

12 Output:1.1Number of new and revised federal policies, plans, and legislation developed with PATHS2 support are consistent with National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard 0 Output:1.2Level of compliance with NHA institutionalization process 20% Output:1.3Number of federal agencies with institutional capacity for HMIS 0% Output:2.1Number of new and revised state policies, plans, and legislation developed with PATHS2 support are consistent with National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard 0% Output:2.2Percentage of budgeted State & LGA funds for health being disbursed To be determined from public expenditure review Output:2.3Percentage of health facilities submitting timely and complete HMIS reports To be determined Output:2.4Number of states with adequate institutional capacity for human resource planning 0%

13 Output: 3.1Percentage of health facilities in PATHS2 supported states with essential drugs consistently available All 4 States: PHC, 4.9%; SHC, 18.5%; Enugu, PHC, 0.0%, SHC,0.0; Jigawa, PHC, 3.8%; SHC, 0.0% ; Kaduna, PHC, 8.5%; SHC, 0.0; Kano, PHC, 6.0%; 35.7% Output: 3.2Percentage of health facilities in PATHS2 supported states providing basic emergency obstetric care services All 4 States: 4.5%; Enugu, 0.0%; Jigawa, 12.5%; Kaduna, 3.3%; Kano, 13.3% Output: 3.3Percentage of clients in PATHS2 supported states re-porting satisfaction with primary health care services All 4 states: 29.1%; Enugu,32.4%; Jigawa, 30.5%; Kaduna, 33.8%; Kano,24.3% Output: 3.4Number of communities in PATHS2 supported LGAs with effective mechanisms to overcome socio-cultural and/or financial barriers to access emergency obstetric care TBD Output: 4.1Percentage of advocacy objectives achieved by PATHS2 supported issue based coalitions 12% Output: 4.2Percentage of functioning facilities within PATHS2 supported LGAs with functioning systems for enforcing health entitlements 0% Output: 4.3Percentage of advocacy objectives achieved by PATHS2 supported issue based coalitions 0% Output: 4.4Percentage of functioning facilities within PATHS2 supported LGAs with functioning systems for enforcing health entitlements 0%

14 Output: 5.1Percentage of people in PATHS2 supported LGAs who have heard of and/or participated in public dialogue on public health issues Enugu: 13.6% Jigawa: 12.5% Kaduna: 16.5% Kano: 12.0% Output: 5.2Number of people in PATHS2 supported LGAs who participated in public health dialogue events with good re-call of public health issues To be determined Output: 5.3Percentage of people in PATHS2 supported LGAs who have adequate knowledge on the signs and prevention of common health conditions Overall, 2.9%; Enugu, 0.0%; Jigawa, 3.1%; Kaduna, 11.1%; Kano, 9.8% Output: 5.4Percentage of people in PATHS2 supported LGAs who can correctly identify health service entitlements Overall, 10.0%; Enugu, 16.2%; Jigawa, 8.3%; Kaduna, 10.1%; Kano: 8.5%

15 Thank you


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