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Nigeria Resource Tracking in Health in Nigeria

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Nigeria Resource Tracking in Health in Nigeria Report No: AUS0000313 . Nigeria Public Disclosure Authorized Resource Tracking in Health in Nigeria Volume II . March 26, 2018 . HNP Public Disclosure Authorized . Public Disclosure Authorized Public Disclosure Authorized 1 . © 2017 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: “World Bank. 2018. Resource Tracking in Health in Nigeria. © World Bank.” All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: [email protected]. 2 RESOURCE TRACKING IN PRIMARY HEALTH CARE IN NIGERIA: CASE STUDY FROM NIGER AND EKITI STATES VOLUME II March 26, 2018 GHN07 Bernard Gauthier, Obert Pimhidzai, Karima Saleh 3 TABLE OF CONTENTS Acknowledgements ........................................................................................................................................ 9 About the authors ........................................................................................................................................ 10 Abbreviations ............................................................................................................................................... 12 CHAPTER 1: Introduction .......................................................................................................................... 14 1.1 Context and Objectives .................................................................................................................... 14 1.2 Methodology and Data ..................................................................................................................... 16 1.3 Main findings ................................................................................................................................... 19 1.4 Organization of the report ................................................................................................................ 25 CHAPTER 2: Background: Policy and Institutional Context in the Health Sector ..................................... 27 2.1 Country Context ............................................................................................................................... 27 2.2. Health indicators .............................................................................................................................. 28 2.3 Socio-economic and health indicators in Ekiti and Niger States ..................................................... 30 2.4 Health System .................................................................................................................................. 31 2.5 Health Expenditure .......................................................................................................................... 32 2.6 Policy reforms toward PHC services ............................................................................................... 34 2.7 Financing of the health sector and PHC Services ............................................................................ 36 2.8 Resource Flows toward PHC facilities ............................................................................................ 38 2.9 Governance and Accountability in the Health system ..................................................................... 40 CHAPTER 3: Methodology ......................................................................................................................... 43 3.1 Rationale of the new PETS approach .............................................................................................. 43 3.2 Overview the new PETS approach .................................................................................................. 44 3.3 Survey instruments and implementation .......................................................................................... 45 3.4 Sampling strategy ............................................................................................................................ 50 3.5 Lessons learnt and challenges .......................................................................................................... 51 CHAPTER 4: Financing of Primary Health Care and Resource Flows toward PHC Facilities .................. 53 4.1 Public Expenditures toward PHC facilities ...................................................................................... 53 4.2 Federal level ..................................................................................................................................... 54 4.3 FMOH allocation vs release of resources ........................................................................................ 55 4.4 State level ......................................................................................................................................... 57 4.5 SMOH allocation vs release of resources in both states .................................................................. 58 4.6 LGA level ........................................................................................................................................ 60 4.7 LGA budget allocation vs release of resources in both states .......................................................... 61 4.8 Transfers .......................................................................................................................................... 64 4 4.9 Overall Public Resources for health and PHC services ................................................................... 66 4.10 Resources available at PHC facility level ........................................................................................ 67 4.11 Overall resources available at PHC level ......................................................................................... 72 CHAPTER 5: Resource availability at primary health care facilities .............................................................. 74 5.1. Overview of methodology for estimating the resource envelop of PHC ......................................... 74 5.1.1. Defining the resource envelop ................................................................................................. 74 5.1.2. Valuation of resources ............................................................................................................. 75 5.2. Main Findings .................................................................................................................................. 76 5.2.1. Sources of Financing................................................................................................................ 76 5.2.2. Adequacy of resources ............................................................................................................. 80 5.3. Financing for drugs and their availability at PHCs .......................................................................... 84 5.4. Summary .............................................................................................................................................. 90 CHAPTER 6: Performance Contingent Incentives To Motivate Behavioral Change ..................................... 91 6.1. Status of Health Care Expenditure Tracking in Nigeria ....................................................................... 91 6.2. Motivating Reporting ....................................................................................................................... 93 6.3. Behavioral Interventions Design...................................................................................................... 95 6.4. Data .................................................................................................................................................. 96 6.5. Implementation Details .................................................................................................................... 97 6.6. Results from the RCT (treated as two independent experiments).................................................. 100 6.6.1. Summary ................................................................................................................................ 100 6.6.2. Part I of RCT: Social Recognition (vs. Comparison) ............................................................ 101 6.6.3. Part II of RCT: Lottery (vs. Social Recognition) ....................................................................... 103 6.6.4. Analytical note on the Data ..................................................................................................
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