Subnational HRH Effort Assessment
Subnational HRH Effort Assessment
One of DPD’s Technical Resources supported a USAID funded Subnational Assessment of HRH Reform efforts across the 36 states in Nigeria. This work was commissioned by the Nigeria Health Commissioners’ Forum (NHCF) with support from Health Workforce management activity (HWMA).
The primary aim was to provide insights into sub-national HRH (Human Resources for Health) policy implementation, practices, progress, and challenges in Nigeria. The study sought to offer evidence- based recommendations for government and health partners to enhance HRH reform efforts.
Technical Approach
The study utilized a cross-sectional design across households, employing both multi-stage probability and non-probability sampling methods. The survey interviewed 420 adults over 18 years of age who were household heads across 9 LGAs in the state to collect information on household characteristics, household health-seeking behavior, satisfaction with existing public health services, income and household expenditure on primary health services, interest in health insurance, and contingent valuation to determine willingness to pay for health insurance under the “Ulerawa” scheme.
The study used a multidimensional approach based on the WHO “HRH Effort Index” (HEI) and included:
Inception Stage:
Conducted a desk review of HRH policies and frameworks, refining methodological underpinnings.
Evaluative Stage:
Implemented an HRH effort indexing survey among State Ministries of Health (SMOHs) and State Primary Health Care Development Agencies (SPHCDAs), gathering responses to 45 questions on six HRH domains. It also included stakeholder roundtable discussions across over 400 key stakeholders from the 6 geo-political zones.
Analysis Stage:
Analyzed data, synthesized findings, and documented recommendations in a preliminary report, reviewed by NHCF and HWM. Composite scores were compared against a performance ranking scale.
Ulerawa Peer-Peer Mentorship Model
DPD developed a peer-to-peer mentorship model for benchmarking, training and performance management of the 177 health facilities within the Ulerawa Scheme. Peer review is an essential process that involves health facilities sharing best practices, assessing their performance, and identifying areas for improvement. This process was aimed at enhancing a bottom-up provider led approach to the quality of healthcare services provided by health facilities whilst promoting healthy competition among facilities.
To achieve this, DPD designed a 3-month dynamic mentee to mentor learning relationship termed “Ulerawa Inter-LGA mentorship” (ILM) to cascade best practices from one LGA focal person to the other. leveraging the expertise and success of the top 8 performing LGAs to support the capacitation of the lowest 8 performing LGAs. In lieu of class style trainings, this collaborative and hands-on effort aims to facilitate knowledge and skill transfer, between the LGA focal persons and the OICs they support. Specifically, the goal of the mentorship program was to achieve the following objectives:
Knowledge Sharing:
Facilitate the exchange of best practices and lessons learned between high-performing and low-performing LGAs to enhance overall performance.
Capacity Building:
Empower focal persons from low-performing LGAs with the necessary skills and knowledge to improve service delivery within their respective areas.
Performance Improvement and Convergence:
Drive tangible improvements in key performance indicators such as community visits, claims submission, complaints resolution, deliveries, under 5s treated, and malaria treatment. Thereby promoting a system of competition and collaboration within the Ulerawa system.
The ILM was preceded by a performance assessment and ranking of participating facilities using key performance indicators such as: Community visits, Claims rejected, Number of childbirths, Number of under 5s treated, and Number of complaints. We utilized the results in implementing the inter- LGA mentorship initiative to foster peer-to peer accountability across LGAs. Using this system, high- performing LGAs mentor and support lower performing ones, for a quarter, after which a re-assessment and ranking is conducted. This approach helped foster knowledge transfer and improved program outcomes.