Assessing Ogbeni Rauf Aregbesola’s Administration in Maternal, Newborn and Child Health: An evidence-based approach in examining the Saving One Million Lives Programme in the State of Osun (2015-2018).
American Philosopher Ralph Waldo Emerson (1803-1882) stated, “The first wealth is health”. By extension, the healthy well-being of a people is closely tied to the economic well-being of the country. The SOML Initiative was launched by the President of Nigeria in October 2012 in response to the poor health outcomes in the country, particularly for mothers and children. It is estimated that almost 1 million women and children die yearly, largely from preventable causes. SOML represents a bold attempt to improve maternal and child health outcomes so that they are more in keeping with the country’s level of wealth; and focuses on six important aspects (pillars) of maternal, newborn and child health (MNCH) that can save lives.
The success of the State of Osun in the health sector, notably, the Saving One Million Lives Programme for Results (SOMLpforR) in the 2018 National Nutrition and Health Survey (NNHS), that earned the state over $20 million dollars would be put on the spotlight vis-a-vis the assessment of the Ogbeni Rauf Aregbesola administration in addressing maternal and child health issues.
The 2018 NNHS survey was conducted between February 19 and June 2, 2018; which is the third national survey using SMART methodology by the National Bureau of Statistics (NBS), in collaboration with National Population Commission and the Nigeria Federal Ministry of Health (FMOH) and with technical support from UNICEF. The ﬁrst NNHS was conducted in February-May 2014 and the second which is the baseline survey in July-September 2015.
The Program for Results (PforR) is a performance-based program of the Federal Government of Nigeria (FGON) assisted by the World Bank. It supports the Government’s existing Saving One Million Lives (SOML) initiative by providing incentives based on achievement of results (health outcomes) and helping to drive institutional processes needed to achieve them. The Program-for-Results (PforR) is not a typical World Bank project which focuses on inputs and activities for procurement using World Bank rules and procedures. Rather, it uses country systems and processes, giving health managers substantial autonomy in managing and producing health results.
The ex-governor of the State of Osun, Ogbeni Rauf Aregbesola on the restoration of healthy living, “My pact with the people of Osun”, popularly known as the green book stated “I shall work to save our people from all avoidable deaths due to accidents, emergencies, poverty and inadequate health facilities”. The Ogbeni administration did realize that most deaths are caused by poverty and inadequate health facilities and should therefore innovate and find workable and sustainable solution to tackle the issues. In 2015, around the time which the baseline survey was to be conducted, the State had started experiencing plummeting allocation coming to the State from the Federal Government, and as such found it hard to fund bulk of the budget in Health. The timely intervention of the SOMLpforR by the FG was a game changer which is focused on improving maternal and Child health.
The Federal Government of Nigeria (FGN) in 2015 received $500million loan from the World Bank to help in reducing maternal and child deaths as well as access to quality health care at the primary level. In 2016, the Federal Government of Nigeria (FGN) disbursed $1.5 million each to all States and the FCT as a supplement to their health budget. The intervention funds were to be utilized towards the goal of improving the lives of mothers and children in Nigeria under the Saving One Million Lives Programme for Results (SOML-PforR). Anticipated disbursements will be based on improvements from the baseline (2015) as measured by national surveys.
It is intended to save the lives of mothers and children by increasing access to utilisation of evidence based, cost-effective and high impact maternal, child and nutrition interventions in Nigeria and change the federal-state relationship to a result-based partnership.
The programme was initiated by the World Bank and Federal Government and has six intervention areas: Immunisation coverage (Pentavalent-3), bed net use by children under five, vitamin A supplementation, Family planning, HIV testing during pregnancy and skilled birth attendance in terms of quantity and quality of care.
The Rauf Aregbesola administration received the first disbursement of $1.5 million dollars in 2016 for the kick-off and is expected to supplement the health budget for the State to improve the quality and quantity of care for mothers and under-5 children. The Aregbesola led government, alias Government unusual, swung into action by allowing the Ministry to take charge of the project. The Commissioner for Health, Dr. Rafiu Isamotu coordinated the program with two objectives: first, to improve on the existing baseline percentage points for the indicators and improving the ranking of the State with respect to the health indicators. This was by no means, a mean feat, as having to plan for such humongous project requires the commitment and dedication of all stakeholders. What makes the period much more interesting was the financial crisis faced by the State owing to the reduction in allocation coming from the FG to the States.
The performance-based strategy employed by the SOMLpforR had to be the motivation for the State in earning more by improving on the indicators as specified by the Program Appraisal (PAD) document of SOMLpforR. The amount given to states was a grant to help in increasing the percentage points for each of the indicators as specified in the PAD of the SOMLpforR. For each percentage point increase for each of the six indicators, it would be multiplied by $205,000.00. It was a chance for Ogbeni to once again prove himself in ensuring the state attains its objectives. In early 2017, the Multiple Indicator Cluster Survey MICS 2016/2017 was released and Osun did not earn any bonus owing to the performance recorded by the State.
Results of the first survey conducted
Osun ranked 15th in MICS 2016/17 with a negative net change in performance when compared with the baseline survey of 2015.
State NNHS 2015 MICS 2016/2017 Points -diff
Zamfara 64.9 112 47.1
Adamawa 164.8 201.6 36.8
FCT 214.9 250.9 36
Katsina 80 114.9 34.9
Yobe 86.5 117.7 31.2
Cross River 247.3 277.4 30.1
Benue 239 266.6 27.6
Kwara 177 202.5 25.5
Rivers 233 254.5 21.5
Bayelsa 153 170 17
Borno 125.2 140.75 15.55
Kogi 188 200.9 12.9
Edo 254.2 262.4 8.2
Anambra 282 277.9 -4.1
Osun 246.1 240.4 -5.7
*NNHS 2015 result was based on five indicators
Source: NNHS 2015, MICS 2016/2017
Osun ranked 15th out of 36 states and the FCT in the MICS survey conducted in 2016/2017. The negative as shown in Table 1 for Osun showed that there was a reduction in performance in the health indicators as specified in the Program Implementation Manual (PIM) of the SOMLpforR for 2016/17 as compared to 2015.
Interestingly, another opportunity came after the 2016/2017 when the Federal Ministry of Health (FMOH), decided to “loan” States $1 million to further carry out interventions that could improve their health indices to enable them win bonus earnings. The money gotten was used in supplementing the budget for health in 2017 and was used in funding programs in the work plan to achieve the objectives set by the Ministry and by extension, the administration of Ogbeni Rauf Aregbesola.
The results showed in Fig 1 (baseline survey, 2015 and NNHS 2018) shows that Osun State had significant increase in all six Maternal and Child Health Indicators most especially in Vitamin A administration and use of Long-Lasting Insecticide treated nets for mothers and under-5 children. Osun did not only improve significantly in those indices but also ranked very high amongst States in the federation and the FCT.
Fig 2 shows the rank of the Osun State (red dot) in the all the indicators measured. In Vitamin A administration, Osun ranked first, placed second in LLIN usage and Contraceptive Prevalence Rate (CPR) and 4th, 5th and 18th position in Skilled Birth Attendant, Penta 3 immunization and HIV Counselling and Testing respectively.
Fig 3 shows how Osun ranked in the cumulative percentage points for the indicators measured. Osun ranked 12th in 2015 with 309.3 points and 2016 but came 1st in 2018 with 418.7 as compared to Lagos’ 370.1 percentage points.
Based on the performance of each state in the Disbursement Linked Indicator (DLI 1.2), the percentage points difference i.e. subtracting the cumulative points for 2015 from 2018 was multiplied by $205,000, with a bonus of $500,000 as Zonal champions for the each of the six geopolitical zones. Also, 12 points was deducted from the percentage points difference, as the expected improvement in two subsequent surveys (MICS 2016/2017 and NNHS 2018) from the baseline. Other disbursements like putting in place Primary Health Care Under One roof (PHCUOR) and having the consolidated budget was also rewarded.
However, only $80,000 was awarded to the State of Osun based on performance management. The PHCUOR and the consolidated budget had been under review by the Independent Verifying Agent (IVA) for the SOML programme. The grand total awarded the State was $20,547,000.00 only. This is illustrated in Table 2
State of Osun Earnings based on DLI 1.2
Breakdown of Earnings Amount ($)
Performance based Disbursements (97.4) points 19,967,000.00
Performance Management 80,000.00
Zonal Champions (South West) 500,000.00
Source: NNHS 2018, SOML-IVA-Report 2018
The biggest Earners
Osun ranked second in the biggest earners chart for the bonus disbursements
and also became zonal champions for the Southwest Nigeria
State NNHS 2015 NNHS 2018 points-diff Disbursement ($)
Yobe 94.2 239.6 133.4 29,007,000.00
Osun 309.3 418.7 97.4 20,547,000.00
Borno 139 249.6 63.5 13,637,500.00
FCT 281.2 335.8 54.6 9,393,000.00
Kano 157 204.2 35.2 8,176,000.00
Nasarawa 260 281.7 33.6 7,548,000.00
Adamawa 198 239 29 7,105,000.00
Niger 188.2 227 26.8 6,454,000.00
Jigawa 211.8 245.7 21.9 5,649,500.00
Taraba 140.4 165.9 13.5 2,927,500.00
Gombe 210 231 9 1,965,000.00
Ondo 311.2 329.6 6.4 1,972,000.00
Zamfara 66.3 79.6 1.3 426,500.00
*NNHS 2015 includes all six indicators
Source: SOML-IVA-Report, 2018
Table 3 shows the biggest earners in Nigeria. The State of Osun ranked 2nd out of the 13 states that got the bonus disbursements. In all, $2.5m was invested and about $20.5m earned with the State making a whooping 800% in returns. Achieving these results did come with a price. A lot of interventions were made to strengthen the health system as well as ensure the objectives set by the Government were met. These are:
Interventions for achieving the results;
- Passage of the creation of State Primary Health Care Board bill in the State House of Assembly in 2018. This SPHCB has its own organ and focuses more on the primary health care. The aim is to have the Primary Health Care in the State Under One Roof (PHCUOR) for effective utilization and control of Primary health care processes and systems.
- Passage of the Osun Health Insurance Scheme bill in 2018. This is to make health affordable at minimal cost most especially to the vulnerable. Part of the funds invested was used as start-up funds for OHIS.
- Immunization: cold room system repairs, maintenance of state cold chain equipment and training of trackers for defaulting, routine immunization supervision and outreaches. The May and November rounds of the Maternal and Child Health week was used to administer immunization to Under-5 children
- Use of LLIN: funds invested were used to support distribution of Long-Lasting insecticide treated nets to 360 Non-Global Fund supported Health Facilities, supported the State LLIN distribution campaign, and post-behavioral change campaign.
- Skilled Birth Attendants: Procurement and distribution of mama kits for mothers, Training of 50 Health Workers, Training of nurses and mid wives on Hand use Ultrasound.
- CPR: training of 100 family service providers across the State, increase in service points offering family planning services in the health facilities. Provision and distribution of contraceptives in designated points.
- HCT: Assessment of health facilities for EMTCT activities, provision of rapid diagnostic kits and consumables, supported the routine distribution of kits and consumables
- Vitamin A: adequate provision of Vitamin A for babies in the May and November rounds of Maternal and Child Health Week (MNCHW).
- Supported Quantitative Integrated Supportive Supervision (QISS) training for 3000 Health workers across the State.
- 30 minute-weekly radio programme on OSBC
- Provision of Office space and start up fund for the Osun Health Insurance Scheme. (OHIS)
- Procurement of 2 surgical machines in the State specialist hospital, Asubiaro, Osogbo.
These breath taking achievement in the health sector, specifically in the quantity of care (SOML DLI 1.2) can be seen as a product of hard work, dedication, commitment and team-playing by all stakeholders ably led by the Ogbeni Rauf Aregbesola administration
Olalekan Oladapo Onanuga, [email protected], 08108511491, 08070695555