{"id":4390,"date":"2019-11-26T19:38:16","date_gmt":"2019-11-26T18:38:16","guid":{"rendered":"http:\/\/www.sina-health.com\/?p=4390"},"modified":"2020-01-10T22:39:10","modified_gmt":"2020-01-10T21:39:10","slug":"francais-messages-du-nigeria-du-liberia-de-la-rca-et-du-sud-soudan","status":"publish","type":"post","link":"https:\/\/www.sina-health.com\/?p=4390","title":{"rendered":"Messages from Nigeria, Liberia, CAR and South Soudan"},"content":{"rendered":"

\"\"<\/a>The 80th<\/sup> international PBF course organised by SINA health in Mombasa-Kenya in November 2019, welcomed 37 participants from Nigeria 19; Liberia 16; South Sudan 1; and CAR 1. Most were from the health sector. Hereby the detailed course report<\/a>.<\/span><\/span><\/p>\n

This course was evaluated by the participants as one of the best since 2007. The criteria<\/span> methods and facilitation<\/em>, <\/span>participation<\/em> and\u00a0organisation<\/i><\/span><\/span>\u00a0<\/i>scored very well with averages of respectively 95% 93%, and 94%. The<\/span>\u00a0final evaluation indicated that for 100% of the participants the content of the course related well to their professional activities and that the methodology of the course was excellent. Yet, 50% of the course participants also commented that the course was too short.<\/span><\/p>\n

NIGERIA<\/strong><\/span><\/p>\n

\"\"<\/a>

\u00a0 The Swahili ruins<\/span><\/p><\/div>\n

With respect to the PBF experiences in Nigeria, the seven States present in Mombasa were mixed. Four states (Bauchi, Borno, Gombe and Ondo) are in the current NSHIP PBF program, but funds will run out by 2020. Three states (Kaduna, Niger and Rivers) wish to set up a PBF systems with their own funding from the start. So, the Nigerian PBF system is at a cross roads.<\/span><\/p>\n

The States present in Mombasa all share similar challenges in their (pre-PBF) health systems. There are insufficient and poorly distributed human resources, inefficient input systems with frequent stock-outs, dilapidated infrastructure, poor quality services, and the verticalization of programmes. Some State representatives describe their current health system as being in a \u201cstate of emergency\u201d.<\/em><\/span><\/p>\n

The course participants agreed, that the World-Bank supported NSHIP program PBF pilots in the states – implemented since 2011 – have produced very good results. As a result, there is the growing consensus that PBF should become the preferred reform approach to achieve Universal Health Coverage in Nigeria. The delegations in Mombasa indicated they wish that PBF moves forward towards a sustainable systems approach.<\/span><\/p>\n

Different World Bank approaches have tested different strategies in Nigeria, but this also created problems in the process.<\/strong><\/span><\/p>\n

\"\"<\/a>

\u00a0Kilimanjaro mountain<\/span><\/p><\/div>\n

(i) The Save One Million Lives (SOML) programme is basically a contract mechanism between the Federal and the State level, without applying PBF best practices at the Local Government Authority – and health facility levels. It therefore became seen as an input project and States used the SOML money in the \u201cbusiness as usual\u201d manner. Its evaluation in 2019 was not favourable.<\/span><\/p>\n

(ii) The decentralised facility financing (DFF) approach was a research idea to finance the control LGAs that were compared with the PBF LGAs but without any verification. This DFF approach had no checks and balances and lacked transparency and it should never have been proposed in the first place. Since 2014, several groups attending the PBF courses in Mombasa proposed to change this DFF approach towards PBF, but these recommendations were ignored for years. DFF created contradictions and may even have contributed to less transparent systems.<\/span><\/p>\n

(iii) In addition, the Bank also developed a Nutrition programme (ANRIN), which has not been harmonised with the PBF reforms. It is unfortunate if this large program would not benefit from the advantages of the decentralised performance approach. It should advocate the local purchasing of supplementary feeding by the health facilities and their communities instead of this being done through centralized input financing. This nutrition program, if it applies the PBF principles, has the potential to create enormous economic multiplier effects.<\/span><\/p>\n

GENERAL RECOMMENDATIONS FOR NIGERIA<\/strong><\/span><\/p>\n