Overall framework, indicators, and
methodologies of tracking
HSS in PATHS2
Ibrahim Ozovehe Yisa, MBBS,MPH, FMCP
Outline of the Presentation
Nigeria: Background and context
PATHS2 Programme
Measuring and tracking progress
Logframe
Baselines
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
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
GOAL
Nigeria's own resources are
efficiently and effectively used to
achieve the MDGS
PURPOSE: To improve the planning, financing and delivery of sustainable and
replicable pro-poor services for common health problems in up to 6 states
Output 1
Output 2
Output 3
Output 4
Output 5
STEWARDSHIP
STATE SYSTEMS
SERVICES and
SUPPLIES
VOICE and
ACCOUNTABILITY
Informed
citizens
POLICY AND PLANNING
CAPACITY DEVELOPMENT
KNOWLEDGE MANAGEMENT
MONITORING AND EVALUATION
PARTNERSHIPS AND CO-ORDINATION
4/13/2015
OPERATIONS RESEARCH
5
4/13/2015
6
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
Baseline survey
General
Objective:
Specific Objectives:
To determine the
situation of Health
Care Service delivery
in PATHS2 Supported
States in Nigeria
To examine the status
of selected supplyand demand-side
health system factors
affecting service
delivery
4/13/2015
To examine the
current status of
service availability
and use in PHC
facilities
To update the baseline
information for the
PATHS2 logframe for
monitoring and
evaluating the
progress of the
programme
8
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)
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
4/13/2015
10
PATHS2 27 Logframe Indicators & Baseline Values
Level
Name of Indicator
Baseline Value
Goal: 1
Goal: 2
Under 5 Mortality Rate
Proportion of births attended by skilled health
personnel
Goal: 3
TB Case Detection Rate
157 deaths per 1000 live births
National: 38.9%; Enugu, 65.5%:
Jigawa 5.1%; Kaduna, 21.8%;
Kano, 12.7%
National: 30.5%; Enugu, 45.5%;
Jigawa, 23.3%; Kaduna, 65.9%;
Kano, 58.7%
National: 10%
Purpose: 1 Level of compliance with the MTSS process in the
preparation of annual performance based budgeting
at federal and state levels
Purpose: 2 Antenatal Care Coverage (4 Visits)
National: 44.8%; Urban, 68.8%;
Rural, 34.4%
Purpose: 3 Proportion of 1 Year old children immunized against National: 41.4%; Enugu, 53.6%;
measles
Jigawa,8.3%; Kaduna, 56.9%;
Kano, 17.8%
Purpose: 4 Percentage of LGAs in PATHS2 Supported states
To be determined
with at least one functioning pro-poor health financing
mechanism (safety nets)
Purpose: 5 Number of states implementing systems
0
strengthening approaches to increase access to
quality services for women and the poorest
Output:1.1
Number 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:1.2
Level of compliance with NHA institutionalization
process
20%
Output:1.3
Number of federal agencies with institutional capacity
for HMIS
0%
Output:2.1
Number 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:2.2
Percentage of budgeted State & LGA funds for health
being disbursed
To be determined from
public expenditure review
Output:2.3
Percentage of health facilities submitting timely and
complete HMIS reports
To be determined
Output:2.4
Number of states with adequate institutional capacity
for human resource planning
0%
Output: 3.1
Percentage 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: 3.2
Percentage 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: 3.3
Percentage 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: 3.4
Number of communities in PATHS2 supported
LGAs with effective mechanisms to overcome
socio-cultural and/or financial barriers to
access emergency obstetric care
TBD
Output: 4.1
Percentage of advocacy objectives achieved
by PATHS2 supported issue based coalitions
12%
Output: 4.2
Percentage of functioning facilities within
PATHS2 supported LGAs with functioning
systems for enforcing health entitlements
0%
Output: 4.3
Percentage of advocacy objectives achieved
by PATHS2 supported issue based coalitions
0%
Output: 4.4
Percentage of functioning facilities within
PATHS2 supported LGAs with functioning
systems for enforcing health entitlements
0%
Output: 5.1
Percentage 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: 5.2
Number 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: 5.3
Percentage 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: 5.4
Percentage 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%
Thank
you