Providing Health in Difficult Contexts: Pre-Pilot PBF Experiences in Adamawa State
Poor health systems are considered to be a major constraint to improving health outcomes. Adamawa State is located in the North-East Region, where the health service performance has been one of the worst in Nigeria (DHS 2013). Its health systems, as in other northern states, has many systemic challenges such as fragmentation and lack of coordination between federal, state and local government, unclear accountability and no incentive for good or poor performance, little resources at the front lines, and weak autonomy at health facilities. Furthermore, since May 2013, the state has been under a “state of emergency” with security threats by insurgency.
Adamawa State started a pre-pilot performance-based financing (PBF) scheme in Fufore Local Government Area (LGA) in December 2011. Over a period of 2 years, despite its “state of emergency” status, the state turned around the health center performance of the pre-pilot LGA. It improved the coverage of critical health services such as institutional delivery, full vaccination and family planning from 2-10% to about 40% (verified operational data). The state fully financed the pre-pilot PBF from its own budget and implemented PBF. Further, it spearheaded the “Primary Health Care under One Roof” initiative and consolidated the fragmented authority into the state (e.g., authority to hire and fire health staff to optimize the workforce). It also made PBF the platform for health service delivery in the state, integrating technical assistance from UNICEF/EU to maximize the potential of the PBF approach.
In this RBF seminar, presenters will highlight the experiences from the Adamawa Performance-based financing (PBF) Pilot, the challenges faced, the early results and how the pilot is leading the way for improved coordination and sustainable health system changes.