Performance Management

The theory of change that underscores the performance management approach assumes that health system leaders, managers and frontline health workers perform optimally when they can be held to account for agreed targets and when they are provided the impetus and inputs to act.

The quality of decisions, policies, implementations made in Nigeria is hampered by a lack of credible evidence both at the policy level as well as at the programmatic level. This is largely driven by challenges with the availability of credible regular (routine) information, in a form that is actionable (a supply‐side constraint), in addition to challenges with the demand for and use of such information, where available (a demand‐side constraint). The demand‐side constraints are primarily attributable to ingrained habits and cultures.

Our Goals

The Performance Management Program has three main goals:

  1. Improve the quantity, quality and use of health data.
  2. Institutionalize performance management for results and strengthen use of data for accountability.
  3. Improve governance and coordination to strengthen program delivery.

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Our Approach

HSDF works with 12 States across all six geopolitical zones (Sokoto, Katsina, Kano, Taraba, Niger, FCT, Imo, Ebonyi, Lagos, Bayelsa, Akwa Ibom and Cross River States) to support the institution of a performance management cycle.

Data employed for performance management include routine health data, state program data and survey data. The District Health Information System platform 2 (DHIS2) is an electronic platform unto which routine health data collected from facilities is entered on a monthly basis. HSDF supports states to increase the quantity and quality of routine data available on the DHIS2.

 
 

Data use and demand

At the state level, HSDF supports the convening of forums for data transparency and problem solving. One such example, is the quarterly steering committee meeting.  These meetings are led by the Commissioner for Health or his designate and draw participation from all departmental directors, program managers, relevant implementing partners and private health sector leadership. The meetings aim to provide a high level update on primary care pillars and drive focused discussions on one or two priority pillars.

To complement the steering committee meetings, HSDF facilitates monthly check-in meetings with Permanent Secretaries of the SMOH and the DPRS. These core meetings provide an opportunity for detailed discussions on all primary pillars, review of data from the DHIS control room and assessment of progress on corrective actions.

Results

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HSDF has been implementing a number of supply and demand side interventions aimed at improving the dearth, quality and demand for health data in supported states. Among the innovative approaches that have been implemented in states has been the establishment and use of a ‘Control Room’‐ a focused monthly intervention that involves active tracking and follow up of monthly reports from all local government areas (LGAs) in the state by the M&E officers of the Department of Planning, Research & Statistics (DPRS) or the Primary Healthcare Board (PHCB).

Since our inception, through continuous engagement with states teams and a strong emphasis on institutionalising a culture of data driven decision-making, notable gains have been observed in the routine health data reporting rates of supported states. Particular attention has been given to engaging the private sector, which is crucial to health care delivery in Nigeria’s mixed healthcare system. HSDF has worked to build consensus within the leadership of the private sector on the importance of health data reporting and has succeeded in improving private facility data reporting across 6 of the supported states

 
 

Ongoing Work

HSDF is providing continuous support to states for:

Data strengthening:

Continuous efforts to strengthen data particularly around instituting a control room, support of quarterly HDCC meeting, improving the analytic capacity of state DPRSs and also focusing on data quality‐ an innovative approach to conducting data quality assurance exercise using text messaging is currently being developed.

Performance management:

HSDF is continuously supporting quarterly steering committee meetings in order to develop the culture of continuous demand and use of health data. Following on from this, our team’s efforts concentrate on building states’ capacity to successfully implement corrective actions.

Increased coordination and ownership of program delivery:

This activity is aimed at supporting states to develop a strong coordination mechanism largely through the partners’ forum and also build capacity of state officials to effectively manage and align multiple stakeholders and programmes.