Ibrahim Ozovehe Yisa, MBBS,MPH, FMCP

Overall framework, indicators, and methodologies of tracking HSS in

PATHS2

Nigeria: Background and context PATHS2 Programme Measuring and tracking progress Logframe Baselines

Outline of the Presentation

Background & Context (I)

Background & Context (II)

04/10/23 5

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

GOALNigeria's own resources are

efficiently and effectively used to achieve the MDGS

04/10/23 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 systemOutput 3: Service Delivery (sustainable, replicable &

pro-poor)• Availability, utilization, quality of care & level of

satisfactionOutput 4: Community engagement (CSM)Output 5: Informed citizens (Ask Nig Project)

• Total of 27 indicators

04/10/23 8

Study Design & MethodologyNigerian 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

studySampling 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 LGASixteen (16) HHs randomly selected from 250 EAsTotal of 4000 HHs randomly selected for the study (Sample

size)

04/10/23 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

PATHS2 27 Logframe Indicators & Baseline ValuesLevel Name of Indicator Baseline Value

Goal: 1 Under 5 Mortality Rate 157 deaths per 1000 live birthsGoal: 2 Proportion of births attended by skilled health

personnelNational: 38.9%; Enugu, 65.5%: Jigawa 5.1%; Kaduna, 21.8%; Kano, 12.7%

Goal: 3 TB Case Detection Rate National: 30.5%; Enugu, 45.5%; Jigawa, 23.3%; Kaduna, 65.9%; Kano, 58.7%

Purpose: 1 Level of compliance with the MTSS process in the preparation of annual performance based budgeting at federal and state levels

National: 10%

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 measles

National: 41.4%; Enugu, 53.6%; Jigawa,8.3%; Kaduna, 56.9%; Kano, 17.8%

Purpose: 4 Percentage of LGAs in PATHS2 Supported states with at least one functioning pro-poor health financing mechanism (safety nets)

To be determined

Purpose: 5 Number of states implementing systems strengthening approaches to increase access to quality services for women and the poorest

0

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