The saving one million lives Initiative was launched in October 2012, in response to the poor health outcomes in the country especially for mothers and children. Thus,the program is intended to improve the lives of mothers and children through a result based partnership with States ministries of health.
On the 16th of March, the team at CODE met with Dr. Ibrahim Kana the Program manager of Saving One Million Lives Program for Results to get an extensive elucidation of how the program is being run and what it entails.
Dr Ibrahim and his team excitedly aligning us on how ($500 million) credit that had been negotiated by Federal government with World Bank from which $1.5million was disbursed to states and FCT as grants, sought to deliver high impact, evidence based and cost effective health interventions based on 6 ‘pillars’, namely:-
– Maternal, newborn and child health;
– childhood essential medicines and increasing treatment of important childhood diseases;
– improving child nutrition;
– malaria control; and
– the prevention of mother to child transmission (PMTCT) of HIV.
He stated that the states were receiving 82% of the money and the program unit is not involved in the spending of the money, also that the SOML Program involves reorienting the discussion of service delivery to results rather than just inputs, establishing a limited set of clear and measurable indicators by which to track success, strengthening data collection so that these indicators can be measured more frequently, bolstering accountability so that managers and health workers at all levels are engaged to achieve better results and fostering innovations that increase the focus on results and include greater openness to working with private sector.
He highlighted that The Program for Result is an approach to structuring of flow of resources to pay for results, outcomes and inputs and under it, states will be rewarded for their performance based on objective indicators using data from household and health facility survey as well as achievement of certain process indicators related to implementation of a performance management system. The program is placed in the Federal Ministry of Health and will be overseen by a Steering Committee chaired by the Honourable Minister of Health and comprising representatives from the state’s commissioner of health which is ultimately responsible for achieving the PforR indicators and ensuring stakeholders’ focus on objectively verified results.
The PforR will provide funds to the federal and state governments based on a set of five Disbursement Linked Indicators (DLIs) which are;
DLI 1.- Increasing Utilization of High Impact Reproductive, Child health and Nutrition Interventions; this will include states producing plans for achieving reductions in Maternal and Under 5 Child mortality, Improvements from states’ baseline on key health indicators such as penta 3 vaccination, insecticides treated nets used by children under 5, contraceptive prevalence rate, Vitamin A coverage, Skilled birth attendance and HIV counselling and testing during antenatal care. Lagging states are also encouraged to strengthen their MNCH weeks as part of an impact evaluation.
DLI 2. – Increasing Quality of High impact Reproductive and Child Health and Nutrition Interventions: This entails states improving the quality of care at primary health care facilities
DLI 3 – Improving Monitoring and Evaluation systems and Data Utilization; by conducting SMART surveys in all 36 states and widely disseminating the results.
DLI 4 – Increasing Utilization and Quality of Reproductive and Child Health and Nutrition Interventions Through Private Sector Innovation: A competitive innovation fund was established that supports innovations for techniques and technologies in health service delivery. This is been headed by the Private Sector Health Alliance of Nigeria.
DLI 5- Increasing Transparency in Management and Budgeting for PHC: States are required to transfer health staff to entity responsible for PHC while produce and publishing a consolidated budget execution report covering all income and expenditures for PHC.
Speaking on the disbursement arrangement, he stated that once state earnings have been determined and verified, the PMU will set in motion the disbursement process. As soon as the World Bank receives a withdrawal application, funds will be disbursed to a dedicated account of the Federal Government for transfer to the accounts states have in Central Bank within 30 days.
The meeting with the Program management unit was very insightful, as a lot of questions we earlier came with were clearly answered but that did not leave us without having a few “asks” and recommendation that we hope will enable us at FollowTheMoney to effectively monitor and track the I.5 million dollars allocated to states.
Recommendations from CODE
Civil Society Organizations be included as part of the Independent Verification Agents
the National Orientation Agency should be carried along in sensitizing the general public about the program.
Specific asks from CODE
we asked to obtain a copy of the State’s Implementation Plans.
Ijeoma Oforka is a Program Officer at Connected Development, with a background in Public Health. She is passionate about advocating for the plights and issues surrounding women and girls health and education. She tweets via @ijoforka
On 23 February 2017, the Director-General (DG) of the Budget Office of the Federation choreographed a media briefing on several issues surrounding the 2017 Budget Proposal. The DG also used the briefing to make certain clarifications on public outcries over several budget items on the proposal. Most of these outcries were on many frivolous items (especially on electricity and utility bills of MDAs; several humongous expenses on the state house budget on utensils and feeding, electricity bills, travel expenses etc.); repetitions of budget items; budget cycle crisis; the budget preparation expenses; lack of details on some of the items; budget padding etc.
In attendance at the briefing were the media and Civil Society Organizations (CSO). In responding to some of these concerns, the DG took his time to counter some of the claims:
1). He stated that there was no sort of budget padding on the 2017 budget proposal.
2). That there were no frivolous items. That most of the extensive increments such as state house proposed expenditure on utensils and utility bills; electricity bills, security and cleaning services payments in MDAs etc. were either as a result of arrears of such bills/expenses or because funds were not later provided for them on the 2016 budget (meaning they were not implemented.)
3). He stated that there were no repetitions on the proposal, unless the repetitions being referred to were budget items on the 2016 one that re-reflected on the 2017 proposal, which was as a result of the fact that funds were not provided for such items on the former.
4). He reassured the audience of his liaison with the National Assembly to ensure that budget cycle would be from January – December of every year, which was clearly stated on the constitution, as against the culture of having a previous budget being implemented in another fiscal year.
5). He also explained that the details-deficit on some of the budget items were as a result of the perspective to keep the budget simple, for public consumption. That however that his agency would ensure further details on budget items when preparing subsequent budgets.
Representing Connected Development (CODE) at the event, I further engaged the DG and raised concerns over the NGN305/$ calculation on the budget proposal (while $1 is valued at NGN 520 at the contemporaneous market); if there are extensive plans for enhanced transparency and accountability in the 2017 budget implementation; our expectancy to lay hands on the 3rd and 4th quarters’ reports of 2016 budget implementation; his plans to ensure that revenue realization deficit would not frustrate the 2017 budget implementation drawing on the country’s experience with the 2016 one; and getting access to an extensive version of the budget that had further details on some of the line items. For the latter, I mentioned the ‘Talking Sanitation’, as well as ‘Afforestation’ and ‘Tree Planting’ budget items on the proposal, under the Ministry of Environment, which all lacked details such as where and how. Lack of such specific details has frustrated the works of CSOs that are into governmental capital expenditure tracking.
In addressing my concerns, the DG made commitments that were all in line with Nigeria’s commitments on the Open Government Partnership. He stated that the 3rd quarter 2016 budget implementation report would soon be in public domain while the 4th quarter’s would soon be out too. He further stated that there would be increased transparency, accountability and citizen engagement in the 2017 budget implementation. On this, he cited plans to have a digital platform for 24/7 citizen engagement on the budget. He also mentioned that there would be a breakdown on project basis subsequently when funds are released to MDAs. In addition, he promised a quarterly media briefing on the 2017 budget implementation. These were all good news and great outcomes for nonprofits that are into Open Governance advocacy. He mentioned categorically that the revenue realization plan on the proposal is quite realizable and that the FOREX regime crisis would not affect the budget implementation.
This media engagement is a step in the right direction as bringing all stakeholders involved and addressing public concerns on the budget proposal have boosted citizen participation in governance and also provided a platform for clarifications on several portions of the budget, as well as for stakeholders to make suggestions. It is hoped that the Director keeps to all the new commitments he made at the briefing and ensuring extensive open financial governance in the budget implementation. From our part, we are sending an FOI request for an extensive version of the budget, which he promised CODE would be provided with. And before I forget, he commented that he likes our name, ‘Follow The Money.’
Chambers Umezulike is a Program Officer at Connected Development and a Development Expert. He spends most of his time writing and choreographing researches on good and economic governance. He tweets via @Prof_Umezulike.
Connected Development [CODE] in partnership with ONE Campaign and The League of Progressive Ambassadors of Nigeria (LEPAN) organized a one week outreach to engage legislators on the #MakeNaijaStronger campaign which is a national health campaign to draw attention to the urgent need for increased public investments to improve health and nutrition outcomes in Nigeria. The Campaign amplifies the calls of various Nigerian organizations that have called on government to priorities increased health investments to help strengthen health systems and save lives.
The aim of the outreach was to get the legislators to sign the petition which calls on the government needs to ensure full implementation of the National Health Act, including more resources and better spending to ensure all Nigerians, including the poorest are able to access health care.
The National Health Act was signed into law by the president on December 9, 2014 with the aim to establish a framework for the regulation, development and management of a National Health System, to set standards for rendering health services in the Federation and other matters concerned, it also provides that there would be improved funding of health care services at the grass root so that people don’t have to travel far to access medical services. This Act will also ensure that states participate in improving health centers through a counterpart fund that would enable them benefit from the consolidated funds.
Getting the legislators to sign the petition was not an easy ride as most of them could not be found at their offices. Those that were around were apprehensive and bluntly refused to append their signature, while some will verbally support the cause and refuse to sign the petition. We also understood that it was a very difficult time for them as previously they just experienced a total blockade of the complex by an aggrieved group and therefore there was little acceptance given to advocacy groups at the moment. Notwithstanding a total of 84 petitions were signed by the legislators.
This shows that 34 distinguished senators and 50 Honourable members are also joining CODE, ONE Campaign, LEPAN and the Nigerian citizens to call on the Government to fully fund the National Health Acts and its provisions, Increase transparency in health programming and spending and also scale up investments in the 2017 budget for areas that can have the greatest health impact for Nigerian citizens in other to #MakeNaijaStronger
CODE participated in the Stakeholder Briefing on Primary Healthcare Centres (PHC) which was held on 29 November 2016 at Spice Platter Gallery, 18 Libreville Crescent, Wuse 2, Abuja. It was choreographed by the Public and Private Development Center (PPDC) and was a briefing on the findings from PHCs visited by PPDC and CODE, in 2016.
PPDC on its part has been mobilizing procurement monitors to track and verify the performance of contracts awarded for projects such as PHCs across the country. This is with the aim of ensuring that public resources are been judiciously utilized in providing public services. CODE also through its Follow the Money initiative has been tracking government implementation of capital funds that are intended for local communities in health, education and environment.
The stakeholders meeting then provided a platform for the two organizations to interact with relevant stakeholders drawn from the National Assembly, State Ministries of Health and several media agencies. The event featured a presentation by PPDC on their procurement and budget tracking works in local communities. In the event, the organization also presented its Budeshi online platform. The online platform is a dedicated site that links budget and procurement data to various public services. It is accessible to the public to interact with and make their own comparisons. This is in a bid to make information around public contracts and procurement process more coherent. Budeshi is also an attempt to demonstrate the Open Contracting Data Standards across the public procurement value chain.
CODE on its part made a presentation on its monitoring of the implementation of capital funds for the rehabilitation of PHCs in Akwa Ibom, Enugu, Kano, Kogi, Osun, and Yobe states. Part of the funds include the $1.5 million health grant from the World Bank to each of the 36 Nigerian states & the FCT and N10.5 earmarked by NPHCDA for the rehabilitation of a PHC in Afia Nsit Urua Nko, Akwa Ibom State. The presentation also accentuated the fact that no sort of implementation is going on with respect to the funds and that governmental agencies are so lackadaisical in replying FOI Requests on further perspicacity on these funds.
The concerned stakeholders such as the personnel from Oyo and Osun States’ Ministries of Health commented that most states have not accessed the World Bank Health Grant. This is contradictory to information that CODE has at this time which is that some states have gotten access. Moreover, our interest is on getting the costed work plan for the grant’s employment, as well as safeguarding citizen engagement on the usage of the fund – which all do not have anything to do with the technicalities of funds provision, assessment, receipt . . . The representative from Osun State Ministry of Health promised to provide the costed work plan of the $1.5 million usage in Osun State to CODE. We hope he does this, and that the State Ministries of Health put information on all the expenditure and intended projects in the public domain.
A leading NGO Connected development [CODE] has called on government at all level to take up one of its responsibilities by ensuring proper facilities are put in place in various primary health care centers in Nigeria.
Following the release of $1.5million dollars from World Bank to the 36 states respectively including the Federal Capital Territory as part of the World Bank supported “Save One million Lives” the Follow the Money team of CODE visited 6 states respectively to assess the state of the PHCs to track the implementation of these funds. These states are Akwa Ibom, Enugu, Kano, Kogi, Osun and Yobe.
Findings from the field visit to each of the states are appalling as most of the Primary Health Centres are facing several reprehensible and elementary challenges. Generically, most of them have no improved water supply, electricity, security, quarters for hospital staffers; there is no stationed doctor, and the toilet facilities are in a mess. Furthermore, because of these challenges, the PHCs do not operate 24/7, cannot admit or treat sick people and lack sufficient tables & chairs.
Some key Findings:
Follow The money team visited Kantudu in Makoda LGA of Kano State. They found out that the PHC serves 2,500 people, all coming from 13 surrounding villages. The PHC was built 5-6 years ago as a senatorial project in Makoda LGA. The PHC has one male and female ward, which are not presently functioning. There are only three staffers with one community health worker who are not certified health professionals.
During the interactive section with the head of community Alhaji Muhammad Musa, and the community association said that they have reached out to the government of Kano twice on the state of the health centre in Kantudu, but there was no response. “We hope this campaign with ONE and CODE will make the government of Kano look at the plight of our health center so that our people can start using it” says Malam Ali, the medical head at the PHC.
In Yobe State
We were in Lantenwa, Yobe where a Primary Health Care is in a messy situation. The PHC in Lantenwa is in Lantewa village, Lantewa ward, Tarmuwa LGA. It serves a population of 13,400 under 5 yrs; 10-15 patients daily, 70-105 weekly. Speaking to the head community ,AuduLantewa, mentioned that the dispensary has been dilapidated for more than 7 years, he added that dispensary situation is critical and he personally reported the issue to local authorities several times. He further lamented that “Lantewa is the gathering centre of four neighbouring with approximately 7,000 registered voters, as such, we should get better things from the government” he said
In Kogi State
We went to the PHC to find out if the implementation of the fund is ongoing as well as to track the implementation of the N10.5 million earmarked by the National Primary Health care Development Agency for the rehabilitation of the PHC. On reaching there, there was no such intervention taking place. The Officer in Charge (OIC) said it was the first time she was hearing of such. The village head whom we paid a courtesy visit to also said he has never heard of such. We then went to the Operational Base of the NsitIbom LGA’s Health Centres and the Director of the base told us that she has never heard of such fund for the PHC’s rehabilitation
In Osun State
Our team went on ground to track the $1.5m earmarked by the World Bank and the Federal Government of Nigeria for the Saving One Million Lives Initiative and all we could see while on the field is nothing to write home about. From our findings, the facility is meant to serve 11 villages which are: Gboore, Alajue-Logun, Asunmo, Ayegbami, Agbopa, Jagun-Odomu, Olodan, Aladie, Amosun, Seesa, Akiribiti amongst others. In total, the target population which the facility is meant to serve is 12,498. 498 of the population are children less than one year, the Primary Health Care Centre has a monthly target of 42 patients, but it ends up serving more than 400 on an average.
Consequently, a Freedom of Information letters was sent to the concerned government institutions and offices for a breakdown of the funds usage, implementation window and respective contractors, especially the governmental institutions concerned, to instantaneously start the implementation of these funds, ensure transparency & accountability in the funds’ implementation, and make government data open in line with the Open Government Partnership.
Follow The Money is a growing movement currently in 32 states of the country, held community outreaches to 10 primary health facilities in Kano, Yobe, Osun, and found out that all were in a state of dysfunction, even with the funds that have been released to the states to upgrade the primary health care “Most of the Clinic at the PHC in the 5 states that our community reporters visited were in an abandoned state, lacks basic healthcare amenities and needs urgent attention to serve people at local communities.” affirmed HamzatLawal, CODE’s Chief Executive & Co-Founder, Follow The Money.
He stressed that annually; Nigeria loses over 99% children below the age of 5 due to dilapidated healthcare services and urges government actions to serve the people by improving better service delivery while ensuring transparency and accountability.
More pictures can be found here https://flic.kr/s/aHskNiNznP
In a bid to safeguard transparency and accountability around several themes concerning the Budget, the Committee on Diaspora and Non-Governmental Organisations (NGOs) of the Nigerian Senate in collaboration with Policy and Legal Advocacy Centre (PLAC) and UK Department for International Development (DFID) on Wednesday, November 3rd, 2016 hosted an Interactive Session. The Session was between the Senate Committee on Diaspora and Non-Governmental Organisations and Civil Society Organisations on Nigeria’s Budgeting System with a Focus on 2016 Budget Performance and 2017 Budget.
The President of the Senate, Dr. Bukola Saraki was available to declare open the Interactive Session. He stated, “The implementation of the 2016 Budget is still ongoing” and added that, “Non-oil revenues are also falling out of projection, affecting the Budget implementation.”
The Chairman, Senate Committee on Diaspora and Non-Governmental Organisations, Senator Rose Oko gave her opening remarks and extensively gave commended the efforts of the NGOs and CSOs partnership that has yielded a whole lot of benefits over the past years.
She said, “At the first session held at Transcorp Hilton on 8th of February 2016, a consensus was reached that a Memorandum of Cooperation be developed.”
According to her, “On the 10th February 2016, another session was held in the Senate Conference room and was attended by the Senate President. A Major outcome of the meeting was the strong position canvassed by the CSOs seeking to be involved in the budgetary process in the National Assembly. The Senate believes that the involvement of CSOs would add value to the budgetary process of the National Assembly.”
She went further to say, “Senate reasoned that their involvement would also help to improve service delivery as government would feel pressured to perform better based on the CSOs budget analysis, general oversight role and information dissemination.”
“Senate therefore considered that the participation of CSOs could strengthen the legislators’ functions on budgetary matters by way of delivering research-based evidence and advice to members of the National Assembly”.
Senator Rose Oko reiterated further that the Senate, “Will use this forum to develop a functional framework that will enable us to achieve enhanced results in the budget system. Fundamentally, this meeting will offer us a crucial window to preview and endorse our Memorandum of Cooperation with a view to affirming the direction of our partnership. This development would enable us to commence without further delay, mutual activities and joint actions beneficial to our Nation”.
She congratulated us all and welcomed us to this new bond of a working relationship between the CSOs and Legislature.
The Chairman of PLAC, Mr. Clement Nwankwo was in attendance and also gave insightful tips on how the Senate can gain the CSOs trust.
He said, “We want to see the figures reeled out as to what has been achieved”. He expressed further that, “The executives should explain to the masses what has happened to the 2016 budget.”
To bring his remarks to a close, he said, “CSOs have questions to ask” and that, “We hope the partnership between CSOs and the Senate will bring good results.”
In attendance also was Dr. Otive Igbuzor, the Executive Director, African Centre for Leadership, Strategy and Development. He gave a detailed speech tailored towards ensuring mutual harmony of the CSOs and Legislature, he was, however very brave to point at the hollow points in the designing strategies of the budget and gave a broader overview.
In his remarks he said, “In Nigeria, there are a lot of blockages to effective budgeting. First and foremost, the budgetary process is not participatory. Citizens and communities do not participate in formulating policies and agreeing on projects that go into the budget. Meanwhile, It has been documented that wherever participatory budget is implemented. It has expanded citizenship, empowered excluded groups, redeemed rights, deepened democracy and stimulated civil society.”
He said, “The budgetary process is not open. Corruption in any country starts from the budgetary process. In very corrupt countries, the budget is done in secrecy. Releases are done without the knowledge of citizens. Procurement information is not made available to Citizens and corruption is guarded and protected.”
He went further, “A budget is regarded as open if Citizens have access to the key budget documents; have high level of involvement in the budgetary process and have access to procurement information.”
Still on citizens participation in the budgetary process, Dr Otive said, “As a matter of fact, democracy will be meaningless if the citizens do not participate in how government raise and spend money. This is why the tool – Open Budget Survey Tracker – developed by the International Budget Partnership is a very useful instrument.”
What he said concerning the budget not being in accordance with the development challenges of the country is that, “There is no synergy between plans, policy and budget. We have always argued that there is the need for better public finance management across the world because of increasing inequality and non-inclusive growth. The past five decades have witnessed monumental changes in the world. Global economic wealth has increased sevenfold and average incomes have tripled.”
He said there are frivolous expenditures in the budget that will not stand any reasoning and logic. “For instance, the Centre for Social Justice documented N668.8 billion frivolous expenditure in the 2016 budget. They include N3.91 billion allocated annual reporting maintenance of villa facilities; N322.4 million for linking of cable to drivers rest room at the villa; N213.8 million for linking cable from guest house to generator house etc.”
He was quick to point at the institutions and mechanisms for oversight of the budgetary process as being weak. He said, “In any modern democracy, the legislature, civil society and media are expected to play oversight functions in addition to the internal control system in place by the executive.”
According to him, there were many lessons learnt from the 2016 budget implementation, some of which are: the Engagement by Citizens and citizens’ groups produced some positive reports in terms of reduction of frivolous expenditure. For instance, CSJ documented a total saving of N71,954,532,546.00 from the 2016.
“Delay in passage of budget continued in 2016. This has the potential to affect budget performance negatively. There was low capacity in understanding the new budgetary approach of zero base budgeting on the part of public servant and civil society,” he asserted.
He also made a deep dive into how Civic Education, Social, Economic and political resilience, budget literacy, comparative analysis of best practice in budgeting are the issues that formulate emerging consensus among civil society that needs to be addressed going forward.
According to Dr. Igbuzor, there are three ways we could measure the impact level performance of the 2016 budget, they are: Input Level, which is how much of the budgeted amount was released and used in the implementation.
Process, how the activities were carried out. Procurement process asks if the activities are carried out as and at when due.
Output, Outcome and Impact levels concerns the immediate result of the activities. The effect of the budget activities or any change attributable to the budget actives and Change in people’s lives attributable to the budget respectively.
He lamented that, “For a very long time, Nigeria had no institutionalised monitoring and evaluation system where there is a regular production of monitoring information; regular production of monitoring findings; and monitoring and evaluation findings are used to improve government performance.”
In conclusion, he commended the National Assembly for the interactive session. He stated, “We need to go a step further by ensuring public hearing in the budget at all levels: Federal, State and Local Government. I undemanding that the leadership of the National Assembly has agreed on the need to subject the budget to Public hearing. The 2017 budget should be the beginning point.”
Positive reactions and towards his remarks came from different sections of the room.
Critical observations and assessment of Citizens’ priorities in Budgeting Formulations was made by Barrister Eze Onyekpere of the Centre for Social Justice.
The representative of Department of International Development prayed prayed that, “It will be helpful if you can ensure this becomes a norm and part and parcel of the legislation in terms of what concerns the citizens.”
The Chief Executive of Connected Development, Hamzat Lawal who was present at the Interactive Session raised the tempo of the hall when he greeted with the assertion that, “There’s a World Bank intervention fund for PHCs across Nigeria, we just came back from Akwa Ibom, Kogi, Osun, Yobe, Enugu, Osun and Kano as we seat, nothing has been done.”
Senator Tejuosho, Chairman Senate Committee on Health also mildly acknowledged that, “Of course The Health Act is one of the declarations that I know we are violating”.
Senator Rose Oko, in her closing remarks said, “We need to work together, the CSOs and the Nation Assembly need to work together.”
“We will recommend a resolution of this interactive session to the Senate for approval”.
Lastly, she assured that, “We will make available to you the conclusion of this meeting.”
The Senate was reminded of their promise that, ”You made a promise to #OpenNASS, please open it up” and this, to me was the highpoint of the Interactive Session.