State Health Investment Project: Impact Evaluation Endline Survey, 2017

Despite years of human and financial investment in the Nigerian Health Sector, the country did not achieve the health-related millennium development goals (MDGs) by 2015. According to a 2010 UNDP MDG report, the likelihood that the country will achieve MDG 4 (reducing under-five mortality by two thirds between 1990 and 2015) and MDG 5 (reducing maternal mortality ratio by three quarters between 1990 and 2015) is average at best. Although the under-five mortality rate fell by a fifth in five years, from 201 deaths/1,000 live births in 2003 to 157 deaths/1,000 live births in 2008, and the maternal mortality ratio fell by 32 percent (800 deaths/100,000 live births in 2003 to 545 deaths/100,000 live births in 2008); these figures do not come close to the two-thirds and three quarters level set for the MDGs. The main challenges to achieving these goals have been identified as “declining resources, ensuring universal access to an essential package of care, improving the quality of healthcare services and increasing demand for health services and providing financial access especially to vulnerable groups” (UNDP 2010).

To overcome these challenges and accelerate the progress of the country to achieving the health related MDGs, innovative approaches are needed to effectively manage the Nigeria health system and improve on its efficiency to enhance the health status of the population. The World Bank and the government of Nigeria are in the process of preparing a results-based financing (RBF) project which provides incentives for improving performance at critical levels within the Nigerian health system and aims to address some of these challenges. A key feature of the RBF project in the Nigerian context is the provision of financial incentives to States and Local Government Agencies (LGA) based on results achieved. In addition, select health facilities will also receive performance incentives. This approach will also build institutional capacity for health system management while introducing a culture of performance excellence at the health facility level and higher levels of health systems management. Given the innovative nature of the proposed project interventions, the World Bank and the Government of Nigeria seek to nest a rigorous impact evaluation in the project to provide evidence that can be used to inform decisions on whether to scale up the innovations implemented under the project. The primary goal of the impact evaluation of the RBF project in Nigeria is to determine if providing financial incentives linked directly to performance increases the quantity and quality of maternal and child health (MCH) services. In addition, it is anticipated that the impact evaluation should provide answers that are generalizable to specific regions in Nigeria.

These are the endline data in support of this impact evaluation.