Measuring Health Policy Development Capacity in Nigeria

Allison Goldberg, Ph.D. CandidateColumbia University

Outline of Presentation

The Purpose Innovative Methodology Baseline Results What’s Next?

Purpose of the Assessment

Provide a baseline assessment of health policies developed at the Federal and State Government levels in Nigeria that can be measured against future policies developed with PATHS2 support

Output 1.1 and 2.1

Number of new and revised state and federal policiesdeveloped with PATHS2 support that are consistent with the National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard

What Are We Measuring and Why is this Important?

Agenda Setting

Policy Evaluation of Effect

on Outcomes

Policy Implementation

Policy Formulation

Feedback

The Policy Cycle

Anderson, James E. (1972). Public Policy-Making. New York: Praeger Publishing.

Methodological Underpinnings

Adaptation of the World Bank and partners’ Performance Measurement Framework (PMF)

An international standard for measuring National and State Government performance across a range of areas (e.g. financial, institutional oversight, service delivery)

SPARC and ESSPIN (Parallel Projects of DFID) also adapted the PMF to assess the institutional functionality of State bodies (e.g. QA, policy & planning, budgetary accountability)

Performance Measurement Framework (June 2005). PEFA Secretariat, World Bank, Washington DC, USA - PEFA includes World Bank, IMF, European Commission, UK, France, Norway, Switzerland and SPA Strategic Partnership with Africa.

Measurement Framework

Minimum Quality StandardClear goals and objectives

Clear and actionable implementation plan

Feasible budgets

Baseline information and research findings and/or national or international policies and guidelines are used to inform the policy development process

Consistent with National Strategic Health Development Plan (NSHDP)The views and opinions of local government, civil society and non-governmental sector actors were taken into consideration

Policies address the needs of disadvantaged groups, such as women and children, the poor, those living with HIV/AIDS, and others

Policies include language that is consistent with the Millennium Development Goals

Domain 1

Domain 2

Scoring The Indicators

Scoring: Consistent with NSHDP (Domain 2)

Policies include language that is consistent with the Millennium Development Goals

Atleast six MDGs are explicitly referenced in the policy and some of the goals and/or objectives are aimed at meeting MDG indicators

A

Atleast half of the MDGs are explicitly referenced in the policy and some of the goals and/or objectives are aimed at meeting MDG indicators

B

Less than half of the MDGs are explicitly referenced in the policy, but none of the goals and objectives are aimed at meeting MDG indicators

C

The MDGs are not explicitly referenced in the policy D

Scoring the Domains

Scoring: Consistent with NSHDP (Domain 2)

Policies include language that is consistent with the Millennium Development Goals

The views and opinions of local government, civil society and non-governmental sector actors were taken into consideration

B

Policies address the needs of disadvantaged groups, such as women and children, the poor, those living with HIV/AIDS, and others

C

Policies include language that is consistent with the Millennium Development Goals

B

Domain II Score

Complete Scoring Matrix

The Policies

National Policies (n=16)

• Revised National Health Policy • National Anti-Malarial Treatment Policy

• National Policy on Population and Sustainable Development

• Nigeria National Medical Laboratory Services Policy

• National Policy on Infant & Young Children Feeding in Nigeria

• National Workplace Policy on HIV/AIDS

• National Policy on Integrated Disease Surveillance & Response

• National Policy on Food & Nutrition in Nigeria

• National Blood Policy • National Human Resource Policy for Health

• National Child Health Policy • National Health Financing Policy 2006

• Health Promotion Policy for Nigeria • Maternal, Newborn, & Child Health in Nigeria

• National Policy on HIV/AIDS • National Health Equipment Policy for Nigeria

State Policies (n=3): Enugu, Jigawa, & Kano State Health Policies

Overall Results

A

B

C

D

Half of the national policies scored a B while the other half scored a C+

Two out of three state policies* earned a score of a D+

Only the State Health Policies of Jigawa, Enugu, and Kano were included the baseline assessment. Few state specific health policies were reviewed since many states follow national policy guidelines

National Policies Disaggregated by Domain

The modal composite scores for the MQS and NSHPD domains were a C+ and an A respectively The policies performed much better in Domain 2: Consistency with the NSHPD

More Results on the National Policy Analyses

MQS (Domain 1) All policies assessed were found to have clear goals and objectives

No policies included a feasible budget

Only two policies* contained a clear and actionable implementation plan

Consistency with the NSHPD (Domain 2)The majority of policies (9) clearly described the process by which

opinions and views of local government, civil society, NGO, and others were included

All but 2 policies explicitly referenced the need of disadvantaged groups (e.g. women, children, people living with HIV/AIDS)

Benchmarks on the use of language consistent with achieving the MDGs were less commonly met than the other indicators assessed

4 policies, including the Child Health Policy and the National Policy on HIV/AIDS, referenced less than half of the MDGs and omitted MDG indicators from the goals and objectives

*National Medical Laboratory Services Policy and the National Human Resource Policy for Health

State Policies Disaggregated by Domain

None of the include actionable implementation plans, budgets, and indications that the policies were evidence-based. Only one policy specified clear objectives 2 policies referenced the need of disadvantage groups None of the policies referenced the MDGs

What’s Next?

Applying same tool in the next 4 months to compare to baseline

Receiving HS 20/20 project funding to link the policy formulation,

policy implementation, and policy evaluation stages

Agenda Setting

Policy Evaluation of Effect

on Outcomes

Policy Implementation

Policy Formulation

Feedback

Anderson, James E. (1972). Public Policy-Making. New York: Praeger Publishing.

Thank you

www.abtassociates.com/HSRsymposium