Eight states, over 2000 primary health centres benefit from NSHIP pilot project

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Executive Director/Chief Executive Officer, National Primary Health Care Development Agency, Dr. Faisal Shuaib

The National State Health Investment Projects (NSHIP) successfully covered over 2,000 health facilities across 113 local government areas in the eight states of Adamawa, Nasarawa, Ondo, Bauchi, Borno, Gombe, Taraba and Yobe.

The beneficiary states have experienced total transformation and become functional with improved quality service delivery at the Primary Healthcare Centre (PHC).

NSHIP is a project of Government if Nigeria with credit from World Bank ad itbtest-run two health financing approaches: Performamcnce- based Financing and Decentralised Facility Financing (PBF & DFF) in 50 percent of the Local Government Areas in the first phase of the three pilot states.

The Executive Director and Chief Executive Officer, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib while speaking at the opening of a two-day on NSHIP and Additional Financing (NSHIP/AF) closure workshop Wednesday in Abuja said, the project transformation transformation has ensured that about 30 million Nigerians, including women and children, have access to quality basic health services and secondary services for continous of care.

Dr. Faisal who was respresnted by Dr. Nneka Onwu, the Director, Community Health Service at the Agency said, the NSHIP was also implemented in the selected health facilities across the IDP Camps in Borno State which housed over 2 million internally displaced persons (IDPs).

“The health outcomes have remained suboptimal in Nigeria despite many years of relatively increasing investments in the Nigerian health system through input financing. This was particularly underscored by the fact that Nigeria was unable to meet most of the health-related Millennium Development Goals (MDGs) targets.”

He also said this necessitated the need to explore different strategy to invest the limited available resources to achieve maximum results in their race to attain the Sustainable Development Goals (SDGs) by 2030.

“As part of the Federal Government’s effort to improve access to quality health care for Nigerians, the National Primary Health Care Development Agency (NPHCDA) commenced the pre-pilot of output-based financing in 2011 under the Nigeria State Health Investment Project (NSHIP) using the experiences from Rwanda, Haiti, Cambodia etc in 3 LGAs, Fufore, Wamba and Ondo-East LGAs in Adamawa, Nasarawa and Ondo states respectively.

“The initial tremendous results shown in the pre-pilot LGAs informed the government’s commitment of USD 171.5 million and USD 145 million (credit/grant from the World Bank) for the scaled up of result-based financing (RBF) to the remaining 49 LGAs across the three Adamawa, Nasarawa and Ondo States as well as extension to 64 LGAs in the remaining five North East States of Bauchi, Borno, Gombe, Taraba and Yobe. This was to rapidly rehabilitate and re-establish health care service delivery as a result of the devastating effect of the insurgency in the area.”

“The implementation of NSHIP was also in line with Federal Government’s Primary Health Care (PHC) revitalization agenda and the initiative of the provision of, at least, one functional PHC per ward across the country in order to attain Universal Health Coverage (UHC) under the President Muhammadu Buhari’s agenda for the health sector.”

He further said the the implementation of NSHIP brought about the paradigm shift from the traditional input-based financing, fragmented and unclear accountability, top-bottom investment approach, no verification and centralized medicine supply to the result-based financing with well-defined and monitored performance indicators, accountability, bottom-up investment decisions, rigorous verification and decentralized medicine and health commodities supply within the PHC landscape. The result has been however unprecedented especially as relate to the achievement of the Agency’s mandates.

“Indeed, the success of NSHIP implementation has brought about significant policy strengthening and changes in Nigeria especially as regards the PHC system strengthening. This include improvement in infrastructure, human resource for health and as well as accountability. The report of the Impact Evaluation of NSHIP, especially on the coverage and quality of health care service provisions informed the Federal Government’s decision to adopt “decentralization”, a key principle in RBF, for the implementation of the Basic Health Care Provision Fund (BHCPF) nationwide. Additionally, the
impact of NSHIP on Essential Medicines Management, Integrated Supportive Supervision (ISS) as well as Health Care Waste Management (HCWM) at the PHC facilities is worth of note. It is also noteworthy that NSHIP contributed by no little means to the fight against the COVID-19 pandemic especially during its first wave in Nigeria as the health facilities contracted under the project were able to quickly respond and adhere to the Federal Government’s guideline on COVID-19.”

The Director, Health Planning and Research, Federal Ministry of Health (FMoH), Bokaji Oladejo at the workshop said, the projects has made a lot of impact that has moved them from a bottom approach.

He said the people took ownership of the facilities and the results are evidence for people to see adding that the focus now should be how the legacy of NSHIP would be sustained as it has closed.

The Senior Health Specialist World Bank, Onoriode Fure said the programme was successful and also very consultative both at the national and state levels.

“It was result oriented and best practices have been established through the project. The NSHIP is a model we can replicate and spend less on health issue if we adopt it,” he said.

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