Ibrahim Ozovehe Yisa , MBBS,MPH, FMCP

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

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

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. 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 STEWARDSHIP Output 2 STATE SYSTEMS Output 3 SERVICES and SUPPLIES Output 4 VOICE and ACCOUNTABILITY Output 5 Informed citizens POLICY AND PLANNING CAPACITY DEVELOPMENT KNOWLEDGE MANAGEMENT MONITORING AND EVALUATION PARTNERSHIPS AND CO-ORDINATION OPERATIONS RESEARCH

6. Framework for Measuring HSS

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

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. 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

15. Thank you