Increasing voice and accountability in the health sector
Better use of Nigeria’s resources has been critical to reduce poverty and accelerate progress towards attaining improved health goals. When the programme started, state and local governments were managing as much as 50 per cent of national revenue and were responsible for most health services. The Partnerships for Transforming Health Systems (PATHS) was a DFID-funded programme which strengthened state and local government health sector systems. The programme ran for two phases and aimed to improve the planning, financing and delivery of sustainable and replicable primary health care services in the states of Enugu, Jigawa, Kaduna, Kano and Lagos.
Options supported citizens and civil society to hold service providers and governments to account for better services, and fostered a health system that responded to the communities’ needs. We used both ‘long-route’ and ‘short-route’ approaches to strengthening accountability through the programme:
- Short-route approaches focused on accountability between citizens/clients and service providers at the community and facility levels. We did this through setting up Facility Health Committees, which were groups of volunteers who together, could represent and act as a spokesperson for people in the community. The committee established a dialogue between the health facility and the community to make sure health services responded to local health needs.
- Long-route approaches improved responsiveness of government to citizens/clients by strengthening the voice of civil society groups, and building their capacity to use data to advocate for better services.
We used community scorecards to assess community participation in health, training and mentoring Facility Health Committees, supporting NGOs to track progress in improving health service delivery.
- We established, trained and mentored 633 Facility/Ward Health Committees. They created stronger linkages between the community and the health service providers and were then embedded within government systems.
- In Lagos, following training, the Ward Health Committees mobilised resources worth NGN 4.7 million to pay for improvements in health facilities.
- We established an alliance for Facility and Ward Health Committees to share lessons learned and best practices from their own experience.
- Three rounds of community scorecards were produced across the states, giving valuable insights into community perception of health services.