FEDERAL GOVERNMENT OF NIGERIA

NATIONAL PRIMARY HEALTHCARE

DEVELOPMENT AGENCY(NPHCDA)

SCORECARD SIX REPORT ON

IMPLEMENTATION STATUS OF
PRIMARY HEALTHCARE UNDER
ONE ROOF (PHCUOR)

SCORECARD 6

DECEMBER 2022
Foreword
Primary Health Care Under One Roof (PHCUOR) is a Primary Health Care (PHC) reform
agenda driven by the National Primary Health Care Development Agency (NPHCDA). The
reform is aimed at reversing fragmentation in primary health care delivery at sub-national
levels by bringing PHC management, human resources, financing and operational
responsibilities under one State level body, the State Primary Health Care Board (SPHCB).

In 2011, the 56th National Council on Health (NCH) adopted PHCUOR as a national policy for
implementation by States and the Federal Capital Territory (FCT). Further to the adoption, the
58th NCH in 2013 approved the PHCUOR Implementation Guidelines, which detail the
institutional framework for PHCUOR. The framework has nine pillars with respective criteria.
The nine pillars are Governance and Ownership, Legislation, Minimum Service Package
(MSP), Repositioning, Systems Development, Operational Guidelines, Human Resources,
Funding Sources & Structure and Office Setup.

The NPHCDA, in collaboration with the SPHCBs and partners, periodically assess the
establishment levels of the PHCUOR institutional framework across the nine pillars using the
scorecard as a tool. The level of implementation of the PHCUOR policy is monitored through
a national Scorecard assessment exercise covering all thirty-six States and the FCT. The
PHCUOR Scorecard assessment measures the progress towards achieving the full
implementation of the PHCUOR policy. It also serves as an advocacy tool to aid decision
makers, health policy advisors, legislators, governing bodies, managers and other
stakeholders drive the changes required to strengthen PHC systems in their states. So far,
five scorecard assessments have been conducted with results widely disseminated.

The most recent scorecard assessment is the PHCUOR Scorecard 6 which was conducted in
August/September 2022. The objectives were to: (a) assess the current establishment status
of PHCUOR institutional framework in the 36 States and FCT, (b) compare individual state
progress in establishing the framework across Scorecards 4, 5 and 6, (c) systematically
identify weak areas within the PHCUOR framework for individual states and recommend
necessary support to improve states performances and (d) generate evidence for use in
advocacy to government and non-government stakeholders on primary health care reform in
Nigeria

The data collected during the 2022 national PHCUOR scorecard 6 assessment exercise have
been analysed leading to di findings and appropriate recommendations contained in this
report. The PHCUOR Scorecard 6 report will be disseminated nationwide to facilitate improved
establishment of the PHCUOR institutional framework by the 36 SPHCBs and FCTPHCB.

Dr. Faisal Shuaib MD, MPH, Dr.PH, OON

Executive Director/CEO
NPHCDA Abuja

i
Acknowledgment
I am very grateful to all those within and outside the National Primary Health Care
Development Agency (NPHCDA) that contributed to the successful outcome of the
2022 National Primary Health Care Under One Roof (PHCUOR) Scorecard 6
assessments in the thirty-six States and Federal Capital Territory (FCT) from the
planning stage to the production of this narrative report.
Our ED/CEO, Dr. Faisal Shuaib was instrumental to the conduct of the PHCUOR
Scorecard 6 assessments right from the early stages and throughout the entire
exercise. ED/CEO’s unflinching support in all aspects was an inspiration to everyone
involved in the exercise.
Very many thanks are due to the officers of the Health Systems Support (HSS) Division
in particular and staff of the Department of Primary Health Care Systems Development
in general, other NPHCDA officers and staff at national, zonal and State levels and
our partners on the Primary Health Care Systems Development Top Management
Team (PHCSD TMT). I should like to express my gratitude for their hardwork and
commitment.
The thirty-six State Primary Health Care Boards (SPHCBs) and FCT Primary Health
Care Board (FCTPHCB) kept the schedule and provided the required information and
data for identifying the strengths and challenges of PHCUOR implementation in each
State which enabled analyses to be done, recommendations to be made and a
comprehensive report to be developed to guide all States and FCT to improve the
delivery of PHC services through PHCUOR implementation.

Dr. Nneka Onwu

Director Primary Health Care Systems Development

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Contents
FOREWORD ................................................................................................................................................i

ACKNOWLEDGEMENTS…………………………………………………………………………………….. ii

LIST OF FIGURES .......................................................................................................................................iii

LIST OF TABLES.........................................................................................................................................vi

ACRONYMS .................................................................................................................................................viii

EXECUTIVE SUMMARY ..............................................................................................................................x

1. BACKGROUND ........................................................................................................................................ 1

2. METHODOLOGY ...................................................................................................................................... 3

2.1. FUNDING OF SCORECARD 6 ............................................................................................................ 6

2.2. LIMITATIONS ................................................................................................................................... 6
2.3. INTERPRETATION OF RESULTS......................................................................................................... 6

3. RESULTS .................................................................................................................................................. 7

3.1. NATIONAL PHCUOR SCORECARD 6 RESULTS ................................................................................. 7

3.2. GEOPOLITICAL ZONES PHCUOR SCORECARD 6 RESULTS ................................................. 8
3.3. STATE PHCUOR SCORECARD 6 RESULTS………………………………………………………..9
Assessing Health Outcome ........................................................................................................... 12
Cross-Cutting Issues across the States ........................................................................................ 13
Recommendations ........................................................................................................................ 14
3.4. STATE PERFORMANCE BY ZONES ………………………………………………………………..15
3.4.1. SOUTH-EAST ZONE .......................................................................................................... 16
ABIA STATE ............................................................................................................................................ 18
ANAMBRA STATE ................................................................................................................................... 19
EBONYI STATE ........................................................................................................................................21.
ENUGU STATE ....................................................................................................................................... 23
IMO STATE.............................................................................................................................................. 25
3.4.2. SOUTH-SOUTH ZONE ....................................................................................................... 28
AKWA-IBOM STATE................................................................................................................................ 30
BAYELSA STATE .................................................................................................................................... 33
CROSS RIVER STATE ............................................................................................................................ 36
DELTA STATE ......................................................................................................................................... 38
EDO STATE............................................................................................................................................. 39
RIVERS STATE ....................................................................................................................................... 41
3.4.3. SOUTH-WEST ZONE ......................................................................................................... 43
OGUN STATE .......................................................................................................................................... 45
ONDO STATE .......................................................................................................................................... 48
OSUN STATE .......................................................................................................................................... 49
OYO STATE ............................................................................................................................................ 51
EKITI STATE ........................................................................................................................................... 53
LAGOS STATE ........................................................................................................................................ 55
3.4.4. NORTH-EAST ZONE .......................................................................................................... 57
ADAMAWA STATE .................................................................................................................................. 59
BAUCHI STATE ....................................................................................................................................... 61
BORNO STATE ....................................................................................................................................... 63
GOMBE STATE ....................................................................................................................................... 65
TARABA STATE ...................................................................................................................................... 67
YOBE STATE .......................................................................................................................................... 70
3.4.5. NORTH CENTRAL ZONE................................................................................................... 71
BENUE STATE ........................................................................................................................................ 73
FEDERAL CAPITAL TERRITORY (FCT)................................................................................................. 76
 KOGI STATE ........................................................................................................................................... 78
KWARA STATE ....................................................................................................................................... 81
NASARAWA STATE ................................................................................................................................ 84
NIGER STATE ......................................................................................................................................... 86
PLATEAU STATE .................................................................................................................................... 87
3.4.6. NORTH-WEST ZONE ......................................................................................................... 88
JIGAWA STATE ....................................................................................................................................... 90
KADUNA STATE ..................................................................................................................................... 93
KANO STATE .......................................................................................................................................... 94
KATSINA STATE ..................................................................................................................................... 96
KEBBI STATE .......................................................................................................................................... 98
SOKOTO STATE ..................................................................................................................................... 99
ZAMFARA STATE ................................................................................................................................. 101
3.5. COMPARATIVE ANALYSIS: SCORECARD 4,5 AND 6 ........................................................................ 103
3.5.1. Tool ................................................................................................................................... 103
3.5.2. Data analysis ..................................................................................................................... 103
3.5.3. NATIONAL RESULTS ................................................................................................................. 105
3.5.4. ZONAL RESULTS ...................................................................................................................... 106
3.5.5. STATE RESULTS ...................................................................................................................... 107
3.5.6. INDIVIDUAL STATE COMPARATIVE DISCUSSION.......................................................................... 110
SOUTH-EAST ZONE .................................................................................................................. 110
ABIA STATE .......................................................................................................................................... 110
ANAMBRA STATE ................................................................................................................................. 110
EBONYI STATE ..................................................................................................................................... 111
ENUGU STATE ..................................................................................................................................... 112
IMO STATE............................................................................................................................................ 112
NORTH-EAST ZONE .................................................................................................................. 113
ADAMAWA STATE ................................................................................................................................ 113
BAUCHI STATE ..................................................................................................................................... 113
BORNO STATE ..................................................................................................................................... 114
GOMBE STATE ..................................................................................................................................... 115
TARABA STATE .................................................................................................................................... 115
YOBE STATE ........................................................................................................................................ 116
NORTH CENTRAL ZONE ........................................................................................................... 116
BENUE STATE ...................................................................................................................................... 116
FEDERAL CAPITAL TERRITORY ......................................................................................................... 117
KOGI STATE ......................................................................................................................................... 118
KWARA STATE ..................................................................................................................................... 118
NASARAWA STATE .............................................................................................................................. 119
NIGER STATE ....................................................................................................................................... 119
PLATEAU STATE .................................................................................................................................. 120
NORTH-WEST ZONE ................................................................................................................. 120
JIGAWA STATE ..................................................................................................................................... 120
KADUNA STATE ................................................................................................................................... 121
KANO STATE ........................................................................................................................................ 121
KATSINA STATE ................................................................................................................................... 122
KEBBI STATE ........................................................................................................................................ 122
SOKOTO STATE ................................................................................................................................... 123
ZAMFARA STATE ................................................................................................................................. 123
SOUTH-WEST ZONE ................................................................................................................. 124
EKITI STATE ......................................................................................................................................... 124
LAGOS STATE ...................................................................................................................................... 125
OGUN STATE ........................................................................................................................................ 125
ONDO STATE ........................................................................................................................................ 126
OSUN STATE ........................................................................................................................................ 126
OYO STATE .......................................................................................................................................... 127
SOUTH-SOUTH ZONE ............................................................................................................... 127
AKWA IBOM STATE .............................................................................................................................. 127
BAYELSA STATE .................................................................................................................................. 128
CROSS RIVER STATE .......................................................................................................................... 128
DELTA STATE ....................................................................................................................................... 129
EDO STATE........................................................................................................................................... 129
RIVERS STATE ..................................................................................................................................... 130
4. REFERENCES ...................................................................................................................................... 142

5. ANNEX ..................................................................................................................................................... 143

List of Figures
Figure 1: Scorecard 6 methodology ..................................................................................... 3

Figure 2: National average performance by pillars ............................................................... 7

Figure 3: Average performance across geopolitical zones.................................................... 8

Figure 4: Average performance across states in percentage................................................ 9

Figure 5: Performance by health service delivery outcome in percentage. ......................... 13

Figure 6: Performance of the South East zone. .................................................................. 16

Figure 7: Abia State Scorecard 6 scores .............................................................................18

. Figure 8: Anambra State Scorecard 6 scores..................................................................... 19

Figure 9: Ebonyi State Scorecard 6 scores ........................................................................ 21

Figure 10: Enugu State Scorecard 6 scores ....................................................................... 23

Figure 11: Imo State Scorecard 6 scores ........................................................................... 25

Figure 12: Performance of the South-South zone............................................................... 28

Figure 13: Akwa Ibom State Scorecard 6 scores ................................................................ 30

Figure 14: Bayelsa State Scorecard 6 scores..................................................................... 33

Figure 15: Cross River State Scorecard 6 scores ............................................................... 36

Figure 16: Delta State Scorecard 6 scores ......................................................................... 38

Figure 17: Edo State Scorecard 6 scores ........................................................................... 39

Figure 18: Rivers State Scorecard 6 scores ....................................................................... 41

Figure 19: Performance of the South-West zone................................................................ 43

Figure 20: Ogun State Scorecard 6 scores......................................................................... 45

Figure 21: Ondo State Scorecard 6 scores ........................................................................ 48

Figure 22: Osun State Scorecard 6 scores......................................................................... 49

Figure 23: Oyo State Scorecard 6 scores ........................................................................... 51

Figure 24: Ekiti State Scorecard 6 scores........................................................................... 53

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Figure 25: Lagos State Scorecard 6 scores........................................................................ 55

Figure 26: Performance of the North-East zone. ................................................................ 57

Figure 27: Adamawa State Scorecard 6 scores.................................................................. 59

Figure 28: Bauchi State Scorecard 6 scores ...................................................................... 60

Figure 29: Borno State Scorecard 6 scores ........................................................................ 63

Figure 30: Gombe State Scorecard 6 scores ..................................................................... 65

Figure 31: Taraba State Scorecard 6 scores ...................................................................... 67

Figure 32: Yobe State Scorecard 6 scores ......................................................................... 70

Figure 33: Performance of the North Central zone. ............................................................ 71

Figure 34: Benue State Scorecard 6 scores ....................................................................... 73

Figure 35: FCT Scorecard 6 scores ................................................................................... 76

Figure 36: Kogi Scorecard 6 scores ................................................................................... 78

Figure 37: Kwara Scorecard 6 scores ................................................................................ 81

Figure 38: Nasarawa Scorecard 6 scores........................................................................... 84

Figure 39: Niger Scorecard 6 scores .................................................................................. 86

Figure 40: Plateau Scorecard 6 scores .............................................................................. 87

Figure 41: Performance of the North-West zone. ............................................................... 88

Figure 42: Jigawa State Scorecard 6 scores ...................................................................... 90

Figure 43: Kaduna State Scorecard 6 scores ..................................................................... 93

Figure 44: Kano State Scorecard 6 scores ......................................................................... 94

Figure 45: Katsina State Scorecard 6 scores ..................................................................... 96

Figure 46: Kebbi State Scorecard 6 scores ........................................................................ 98

Figure 47: Sokoto State Scorecard 6 scores ...................................................................... 99

Figure 48: Zamfara State Scorecard 6 scores .................................................................. 102

Figure 49: Comparison of national average performance across all pillars ....................... 105

Figure 50: Zonal performance for scorecards 4,5,6 .......................................................... 106

Figure 51: States performance across the period in view (SC4-SC6) 2018-2022. ............ 108
List of Tables
Table 1: Data collection schedule ......................................................................................... 5

Table 2: Illustration of states’ PHCUOR performance. Green: Good; Yellow: Fair; Red: Poor
............................................................................................................................................. 9

Table 3: Cross-cutting issues ............................................................................................. 13

Table 4: Performance by states .......................................................................................... 17

......................................................19
Table 5: Components to Improve Anambra state................

Table 6: Components to Improve Ebonyi state ...................... ...............................................22

Table 7: Components to Improve Enugu State ................................................................... 23

Table 8: Components to Improve Imo state ........................................................................ 26

Table 9: Performance of the South-South states ................................................................ 29

Table 10: Components to Improve Akwa Ibom state ...................................................... 31

Table 11: Components to Improve Bayelsa State ............................................................... 33

Table 12: Components to Improve Cross River State ......................................................... 36

Table 13: Components to Improve Delta state .................................................................... 38

Table 14: Components to Improve Edo state .................................................................. 39

Table 15: Components to Improve Rivers State.................................................................. 41

Table 16: Components to Improve Ogun State ................................................................... 45

Table 17: Components to Improve Ondo State ................................................................... 48

Table 18: Components to Improve Osun State ................................................................... 49

Table 19: Components to Improve Oyo State ..................................................................... 51

Table 20: Components to Improve Ekiti State ..................................................................... 53

Table 21: Components to Improve Lagos State .................................................................. 55

Table 22: North East States’ performance .......................................................................... 58

Table 23: Components to Improve Adamawa State ............................................................ 59

Table 24: Components to Improve Bauchi State ................................................................. 62

Table 25: Components to Improve Borno State .................................................................. 64

Table 26: Components to Improve Gombe State ................................................................ 66

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Table 27: Components to Improve Taraba State ................................................................ 67

Table 28: Components to Improve Yobe State ................................................................... 70

Table 29: North Central States’ Performance ..................................................................... 72

Table 30: Components to Improve Benue State ................................................................. 74

Table 31: Components to Improve Federal Capital Territory............................................... 76

Table 32: Components to Improve Kogi State .................................................................... 78

Table 33: Components to Improve Kwara State.................................................................. 81

Table 34: Components to Improve Nasarawa State ........................................................... 84

Table 35: Components to Improve Niger State ................................................................... 86

Table 36: Components to Improve Plateau State ............................................................... 87

Table 37: North-West States’ Performance......................................................................... 89

Table 38: Components to Improve Jigawa State ................................................................ 91

Table 39: Components to Improve Kaduna State ............................................................... 93

Table 40: Components to Improve Kano State ................................................................... 94

Table 41: Components to Improve Katsina State................................................................ 96

Table 42: Components to Improve Kebbi State .................................................................. 98

Table 43: Components to Improve Sokoto State ................................................................ 99

Table 44: Components to Improve Zamfara State ............................................................ 102

Table 45: States’ Scorecard from SC4-SC6 (2018-2022)…………………………………… 108

Table 46: Abia State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …………... 110

Table 47: Anambra State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………111

Table 48: Ebonyi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …………112

Table 49: Enugu State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………….113

Table 50: Imo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……………..114

Table 51: Adamawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …… 115

Table 52: Bauchi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 116

Table 53: Borno State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 117

Table 54: Gombe State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……… 118
Table 55: Taraba State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……… 119

Table 56: Yobe State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 120

Table 57: Benue State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………. 121

Table 58: FCT PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………………… 122

Table 59: Kogi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …………. 123

Table 60: Kwara State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 124

Table 61: Nasarawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …. 125

Table 62: Niger State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 126

Table 63: Plateau State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …….. 127

Table 64: Jigawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……… 128

Table 65: Kaduna State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …….. 129

Table 66: Kano State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 130

Table 67: Katsina State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………. 131

Table 68: Kebbi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 132

Table 69: Sokoto State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 133

Table 70: Zamfara State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……… 134

Table 71: Ekiti State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 135

Table 72: Lagos State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………. 135

Table 73: Ogun State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 136

Table 74: Ondo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………. 136

Table 75: Osun State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ……….. 137

Table 76: Oyo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 137

Table 77: Akwa-Ibom State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …. 138

Table 78: Bayelsa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …….. 138

Table 79: Cross River State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …. 139

Table 80: Delta State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………… 139

Table 81: Edo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) …………. 140

Table 82: Rivers State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022) ………. 140
Acronyms
AIDS Acquired Immunodeficiency Syndrome

AOP Annual Operational Plan

BHCPF Basic Health Care Provision Fund

DHIS2 District Health Information Software 2

ES Executive Secretary

FCT Federal Capital Territory

FGN Federal Government of Nigeria

FMoH Federal Ministry of Health

HCoH Honourable Commissioner of Health

HMIS Health Management Information System

HIV Human Immunodeficiency Virus

HERFON Health Reform Foundation of Nigeria

HRH Human Resources for Health

HRIS Human Resource Information System

IMR Infant Mortality Rate

ISS Integrated Supportive Supervision

LGA Local Government Area

LGHA Local Government Health Authority

LGSC Local Government Service Commission

SMoLG State Ministry of Local Government

M&E Monitoring & Evaluation

MICS Multiple Indicator Cluster Survey

MSP Minimum Service Package

NCH National Council on Health

NDHS Nigeria Demographic and Health Survey

NGF Nigeria Governors’ Forum

NMR Neonatal Mortality Rate

viii
NPHCDA National Primary Health Care Development Agency

PHC Primary Health Care

PHC TMT Primary Health Care Top Management Team

PHCUOR Primary Health Care Under One Roof

SC4 Scorecard 4

SC5 Scorecard 5

SC6 Scorecard 6

SHC Secondary Health Care

SMoH State Ministry of Health

SPHCB State Primary Health Care Board

TBL Tuberculosis and Leprosy

U5 Under Five

UHC Universal Health Coverage

U5MR Under Five Mortality Rate

WDC Ward Development Committee

WMHCP Ward Minimum Health Care Package

Executive Summary
This report highlights findings from Scorecard 6 assessment of Primary Health Care Under
One Roof (PHCUOR) that was conducted between August and October 2022. It summarises
establishment status of PHCUOR institutional framework in the country by drawing findings
from the states, and avail a comparative analysis of states’ progress from Scorecard 4 (2018
assessment), Scorecard 5 (2019 assessment), to Scorecard 6 (2022 assessment).

Results of the Scorecard 6 assessment reveal significant progress in the establishment of the
PHCUOR institutional framework. Nigeria recorded a national average score of 76%, which is
a 3% increase from the previous Scorecard 5 (73%). However, more efforts are required to
achieve the expected target of 90%.

All states have established their SPHCBs, albeit at varying levels of operationalisation, with
significant performance recorded in the Scorecard 6 assessment. Sixty-two (62) percent of
the states surpassed the expected target of 90% i.e., a 40% increase when compared to the
SC5 results. Several positions had a tie including the 2nd (Niger - 99%, Plateau - 99%), 4th
(Kaduna - 98%, Kebbi - 98%, Zamfara - 98%), 7th (Ondo - 96%, Yobe - 96%) 9th (Delta - 95%,
Bauchi - 95%). Abia state was the only state that scored 100% (gold badge). Other states with
90-99% (silver badge) include those mentioned above on the tied positions and Adamawa
(91%), Enugu (90%). Nineteen percent (19%) of the states recorded poor performance (0-
49%) including Ogun state at 26%.

Insights from the comparative analysis show that there has been appreciable improvement in
the establishment of PHCUOR institutional framework from 2018 to 2022. Most of the pillars
recorded incremental performance through the three scorecards (SC4, SC5, SC6) despite
modification of the data collection tools. This shows commitment of the NPHCDA and SPHCB
leads in achieving PHCUOR for improved health care delivery. On the average, Nigeria
recorded a 43% performance increase since 2018 (SC4) in the establishment of PHCUOR
framework. The pillars driving this performance are MSP, Legislation and Repositioning. For
instance, in 2018 (SC4), the MSP pillar performance was 7% and in 2022 (SC6) the pillar
recorded a score of 52% i.e., a 643% percentage increase - highest performance increase
across the pillars. Nonetheless, the MSP pillar requires continued support to surpass the
expected target of 90%. All pillars recorded significant average performance increase, except
for Office Setup which had a performance decline of -15%; but sharp decline when compared
with SC5 and SC6 performance i.e. from 100% to 0%.

The Repositioning pillar, which is at the core of PHCUOR recorded significant improvement in
SC6. This may be attributed to the modification of one of the questions in the data collection
tool which was previously ‘transfer of Malaria, HIV/AIDS, TBL to SPHCB’ and now revised to
be ‘availability of a desk officer for Malaria, TBL, HIV/AIDS in the SPHCB’.

Thirty five percent (35%) of the states recorded high year-on-year performance increase
including Abia, Enugu, Bauchi, Borno (from 60% - 31st position in SC5 to 88% - 13th position
in SC6), Yobe, Niger, Plateau (from 63% - 28th position in SC5 to 99% - 2nd position in SC6),
Kano, Kebbi, Zamfara, Ondo, Delta, Rivers. All other states recorded varied year-on-year
performance increase except Kogi, Kwara, Ogun States that has consistently recorded
abysmal performance through the period in view and require urgent attention.

In conclusion, the PHCUOR reform agenda has received wide acceptance as evidenced by
the efforts and improved performance in establishing its institutional framework nationwide.
For instance, in the SC6, Ekiti state maintained same score (82%) as SC5 but moved from
the 12th position in SC5 to 19th position in SC6. Additionally, the PHCUOR scorecard is
becoming an opinion driver in stewarding primary health care in Nigeria and a key advocacy

x
tool in the country. To continue improving primary health care governance for overall PHC
performance, the following are recommended for the NPHCDA and other stakeholders:

Recommendations

NPHCDA

• Continue the support to strengthen MSP, Repositioning and Legislation pillars

• Provide special intervention to Akwa-Ibom, Kogi, Kwara, Oyo and Ogun States Primary
Health Care Boards to improve performance

• Institutionalize peer learning and encourage high performing states such as Abia,
Niger, Plateau to provide peer mentoring to other states

• Support states to ensure that all SPHCB staff including those in the LGHAs are on the
payroll of the SPHCB

States

• Akwa-Ibom, Kogi, Kwara, Oyo and Ogun States should actively seek and leverage
technical assistance from peer states, NPHCDA to improve on identified weak areas

• Abia, Niger, Plateau States should peer mentor other states to fully implement
PHCUOR

• States should periodically self-assess their PHCUOR implementation status to reduce

or completely eliminate varied performance as recorded in the SC6 comparative
analysis section

LGHAs

• Develop and incorporate LGA level AOP, M&E results/performance framework into
state level document

• Track implementation progress of AOP and M&E performance framework

• Contribute to creating awareness and improving knowledge on PHCUOR

implementation guidelines and other PHC related strategy documents at the sub-state
level

• Facilitate LGA PHC budget performance

Partners

• Provide technical and financial assistance to states, particularly poorly performing

states, to fully establish PHCUOR institutional framework and transit to implementation
of PHCUOR

Challenges

The tools used to conduct Scorecards 4, 5, 6 assessments were different; the tool for
Scorecard 5 was adapted for Scorecard 6 assessment. However, data analysis of the three
scorecards were carefully and rigorously done to ensure seamless comparison of likes.
Limitations

Although the Scorecard is used to assess the institutional framework in place for effective
PHCUOR implementation, it, however, cannot be used to indicate strengthened PHC systems
and/ or improvement in health outcomes. This additional perspective, however, is proposed
as a mandatory feature for subsequent scorecards.
1. Background
Primary Health Care Under One Roof (PHCUOR) is a Primary Health Care (PHC) reform
agenda driven by the Federal Government of Nigeria (FGN). This reform is aimed at reversing
fragmentation in primary health care delivery (particularly at sub-national levels) by
centralising PHC management, human resources, financing and operational responsibilities
under one State level body; the State Primary Health Care Board (SPHCB).

In 2011, the 56th National Council on Health (NCH) adopted PHCUOR as a national policy for
implementation by States and the Federal Capital Territory (FCT). Further to the adoption, the
58th NCH in 2013 approved the PHCUOR Implementation Guidelines, which detail the
institutional framework for PHCUOR. The framework has nine pillars with respective criteria.
The nine pillars are Governance and Ownership, Legislation, Minimum Service Package
(MSP), Repositioning, Systems Development, Operational Guidelines, Human Resources,
Funding Sources & Structure and Office Setup. Details of each pillar can be found in Annex
1.

Recently, the implementation guidelines were revised to reflect new thinking. For instance,
where the previous guidelines were ambiguous on nomenclature of the primary health care
structures at sub national levels (state and LGA), the revised guidelines have addressed this
ambiguity and provided clear nomenclature for these structures. The state primary health care
bodies are referred to as State Primary Health Care Board while the LGA bodies are referred
to as Local Government Health Authorities, with the leads referred to as Local Government
Health Secretaries. Additionally, where the previous guidelines stated transfer of malaria, TBL,
HIV/AIDS to the SPHCB on the Repositioning pillar, the revised guidelines have been changed
to reflect availability of a desk officer for the respective programs in the SPHCB.

The NPHCDA, in collaboration with partners, periodically assess the establishment levels of
the PHCUOR institutional framework across the nine pillars using the scorecard as a tool. It
does not currently assess or attempt to assess the strength of primary health care systems
and its impact on health outcomes. The expectation is that future scorecards will be designed
to measure actual implementation of PHCUOR and its impact on health outcomes. By then,
all states would have fully established the institutional framework.

Currently, the scorecard provides insights into states’ progress with establishing the
framework and facilitates support for weak areas. It also serves as an advocacy tool to aid
decision makers, health policy advisors, legislators, governing bodies, managers and other
stakeholders drive the changes required to strengthen PHC systems in their states. So far,
four scorecard assessments have been conducted, with results widely disseminated. The
most recent scorecard assessment is the Scorecard 6, which was conducted in 2022, and has
informed this report. The Scorecard 6 assessment report will be disseminated nationwide to
facilitate improved establishment of the PHCUOR institutional framework.

Objectives of Scorecard 6 Assessment

• Assess status of establishment of PHCUOR institutional framework in the 36 States

and FCT

• Systematically identify gaps in the establishment of PHCUOR framework for individual

states and provide recommendations

• Conduct a comparative analysis for establishment of PHCUOR framework using data

from scorecards 4,5 and 6

1
• Generate evidence for use in advocacy to government and non-government
stakeholders on primary health care reform in Nigeria

2
2. Methodology
A ten-step process was adopted for PHCUOR Scorecard six assessment. Refer to Figure 1.

Engage Develop Review Pre-test Code Train Collect Analyse Control Report

Figure 1: Scorecard 6 methodology

Step 1: Engagement of Stakeholders

Stakeholders were widely engaged and consulted to conduct the PHCUOR Scorecard 6
assessment. The stakeholders included officials from Federal Ministry of Health (FMoH),
NPHCDA, National Council on Health, Honourable Commissioners, Executive Secretaries of
SPHCBs, implementing partners, Civil Society Organisations. Ahead of the assessment,
formal letters were sent to Honourable Commissioners for Health of all states plus FCT to
inform and prepare them for the assessment. The letter detailed assessment objectives,
method, timetable, names of assessors for individual states and list of documents to provide
for sighting and submission.

Step 2: Development of Assessment Protocol

The protocol for assessment, which includes methodology and detailed activities with dates
(agreed by all stakeholders), was developed and approved. Assessment was conducted at
three levels in the states: SPHCB, Local Government Health Authorities (LGHA), and health
facilities -

• Day 1-2: Assessors met with the Executive Secretaries of the SPHCBs as first entry
activity and paid courtesy visit to the Honourable Commissioner for Health (HCoH) or
designate to register presence in the state and provide overview of the assessment.
The courtesy visit was led by the Executive Secretary of SPHCB

• Days 3-5: the assessment was conducted across all levels (state, LGHA, health
facilities)

• Day 6: Assessors debriefed the SPHCB Executive Secretary and the Honourable
Commissioner for Health on the exercise including providing preliminary findings and
recommendations before exiting the state. These activities were necessary to ensure
state-wide ownership, awareness, and engagement throughout the assessment

Step 3: Review of Assessment Tools

The Scorecard 5 tool was revised and used to conduct the Scorecard 6 assessment. This was
done to reflect new thinking and recommendations from the Scorecard 5 report. The review
resulted in inclusion of additional questions to 8 out of the 9 PHCUOR pillars. Fifteen questions
were added in total, with 3 questions modified. All questions can be found in Annex 2.

To enhance the tool’s sensitivity, questions were allotted individual scores and the pillars were
weighted based on relevance. The reviewed Scorecard 6 tool was abridged for the sub-state
levels and to enable corroboration across the levels (State, LGHA, health facilities). The tool
was designed such that answers from the LGHA and health facilities’ questionnaire can be
used to validate state level answers. For example:

3
 • PHCUOR state tool: Is there a State PHC Annual Operational Plan (AOP) with budget
incorporating all LGHA Annual Operational Plans?

• PHCUOR LGHA tool: Is there a LGHA PHC Annual Operational Plan?

• PHCUOR health facility tool: does the facility have an Annual Operational Plan?

If the state level answer to the sample question above is ‘yes’, response from the LGHAs and
facilities are expected to be ‘yes’ also. However, in a situation where the state level answer
and that of the other levels conflict, the state automatically scores nothing for that question.

Step 4: Pretesting and Finalisation of Assessment Tool

To ascertain the reliability and validity of the Scorecard 6 tool, a pre-test was conducted in
FCT PHCB, three pre-selected LGHAs and one health facility within the selected LGHAs in
the State. The tool was then revised to incorporate feedback from the pre-test, finalised and
presented to the PHC TMT, including implementing partners, for review and adoption ahead
of the assessment.

Step 5: Coding of the Tool

Following adoption of the Scorecard 6 tool, it was coded onto mobile phones (using Open
Data Kits – ODK collect app) to facilitate easy data collection by the assessors. The platform
enabled data collection and electronic real-time upload to the central server. Additionally,
mechanisms were built-in to track dates, geo-coordinates, and time of assessment at the
different levels in every state. Some questions also required image capture (e.g., a document
– law, regulation) before proceeding to the next question. This was done to enhance
transparency and credibility of the assessment.

Step 6: Selection and Training of Assessors

Assessors were selected and trained. Team assessors for each state consisted of two
members: NPHCDA team lead from Abuja headquarters and NPHCDA state coordinator from
contiguous states (away from their primary state of assignment but within same geopolitical
zone) to avoid bias. One-day training was conducted for all team leaders at the NPHCDA
headquarters in Abuja. The training covered methodology of assessment, use of ODK for data
collection, collation and expected deliverables.

Step 7: Data Collection across 36 States & FCT

Data collection was conducted in all 36 States and the FCT in three phases (refer to Table 1).
Prior to deployment of assessors, states were notified in writing about the procedures. Three
assessors were assigned to each state with clear instructions to collect evidence for positive
responses and visit three LGHAs (one per senatorial zone) outside the state capital and one
facility per each of the LGHAs.

4
Table 1: Data collection schedule

Phase Geopolitical zone Date of data collection

First South East and South West 14 – 21 August 2022

Second South-South and North Central 21 – 27 August 2022

Third North-West and North East 28 August – 3 September

2022

Step 8: Quality Control

Data collection was done using ODK App installed on android mobile phones and was
uploaded to a central server for quality assurance. It was subsequently cleaned, and unclear
responses clarified with relevant state Assessors. Three key quality control measures were
introduced in Scorecard 6:

• Image capture of key documents when state answers ‘yes’ to availability of the
document; without this image capture, assessor cannot proceed to the next question

• Introduction of questions that help to validate answers across all levels (State, LGHA
and health facility)

• Introduction of skip function/pattern to the configured questions. For instance, under

the Legislation pillar, if a state answers ‘No’ to question 2.1 (Has the SPHCB Law been
signed into Law by the Executive Governor and gazetted), the questionnaire
automatically skips to the next pillar. Thereby scoring the state ‘0’ for the Legislation
pillar. This demonstrates that a Law yet to be signed means no SPHCB law.

Step 9: Data Analysis for Comparison

Data analysis was rigorous. Questions across all the levels were triangulated to ensure
consistency; for questions where states said they had a document; an image of such
document was matched for validity. As a rule, any positive answer to the scorecard tool which
was not backed by documentary evidence was changed to a negative response. It was also
agreed that only evidence available as at the time of data collection and analysis would be
accepted. Any progress made by any state outside the assessment period was excluded from
the validation process.

Considering that Scorecard 6 serves the dual purpose of assessing states’ PHCUOR
framework establishment status and trend analysis using data from Scorecards 4, 5, 6, the
data analysis process incorporated mechanisms to achieve the purpose. These mechanisms
included using only PHCUOR pillar scores. The analysed results underwent multi-level
validation to ascertain the exact status of establishing PHCUOR institutional framework and
eliminate any ambiguities. The validated results for all 36 states and the FCT were

5
unanimously accepted by stakeholders as the final and official results of the PHCUOR
Scorecard 6 assessment.

Step 10: Report Writing

The adopted results were used to develop the PHCUOR Scorecard 6 report.

2.1. Funding of Scorecard 6 Assessment

The Scorecard 6 assessment was funded and conducted (from data collection to reporting
and printing of reports) by the NPHCDA.

2.2. Limitations
Although the PHCUOR Scorecard 6 recorded progress in the establishment of the institutional
framework, the exercise had some limitations:

1. The Scorecard 6 assessment focused on assessing the establishment of PHCUOR

institutional framework for effective PHCUOR and not on assessing primary health
care systems or service delivery. Therefore, the extent to which results obtained
translate to actual strengthening of PHC systems and contribute to improved health
outcomes is beyond the scope of this scorecard. The next step for the scorecard could
be to evaluate implementation of PHCUOR and its impact on PHC system
performance and health outcomes. Establishment of the institutional framework is the
first step in stewarding PHCUOR implementation

2. Extraction of health outcome scores from Scorecard 4 MSP pillar to enable comparison
with Scorecard 5 and 6 may distort Scorecard 4 overall scores for states and even
national. However, the extraction does not affect the printed and disseminated
Scorecard 4 scores

3. The time-lag between completing the PHCUOR Scorecard 6 assessment and drafting
the report suggests that some states may have made further progress that are not
captured in this report.

4. States that may have some PHCUOR requirements but did not produce evidence of
such requirements at the time of data collection were not credited for such claims. This
was to ensure that all accepted claims are valid.

2.3. Interpretation of Results

From the results, states and the FCT have made progress in establishing institutional
framework for Primary Health Care Under One Roof (PHCUOR). Furthermore, pillar
performance, represented by percentages, shows aggregate scores for the establishment of
criteria per pillar across the states.

6
3. Results
3.1. National PHCUOR Scorecard 6 Results

National PHCUOR Scorecard 6 Result

100% 90%
84% 86%
90% 81% 79%
77% 77% 74%
80% 72%
70%
60% 52%
50%
40%
30%
20%
10%
0%

Figure 2: National average performance by pillars

Results of the Scorecard 6 assessment show progress in the establishment of the PHCUOR
institutional framework. Nigeria recorded a national average score of 76%, i.e., a 3% increase
from that of scorecard 5 (73%). However, it is yet to achieve the expected target of 90%.
Additionally, none of the individual pillars met the expected target of 90%.

Funding Sources, Governance & Ownership and Legislation pillars had the highest scores at
86%, 84% and 81% respectively. MSP and Office Setup pillars recorded a 7% and 8% decline
respectively when compared to Scorecard 5 performance while Governance & Ownership
recorded the highest performance increase at 10% when compared to Scorecard 5
performance.

The MSP pillar remains the least performing pillar nationwide at 52%. Only 11 (30%) states
namely Abia, Bauchi, Ebonyi, FCT, Kaduna, Kano, Kebbi, Ondo, Osun, Sokoto, Yobe
achieved a 100% score. Forty one percent (41%) of the states have zero score for MSP. The
reoccurring pillar criteria gap include ‘availability of an approved and costed MSP’, ‘availability
of investment plan to aid annual implementation of the MSP’, ‘incorporation of the investment
plan into the state annual budget’, ‘consideration of state fiscal space in the development of
the investment plan’, ‘availability of the health input gap analysis report’, ‘dissemination of an
approved and costed MSP to all stakeholders.

The Repositioning pillar is at the core of PHCUOR and has recorded a consistent performance
increase when compared to scorecards 4&5. Although it recorded a 13% performance
increase when compared to the SC5 performance, it has consistently posed the most
challenge for states. Some of the challenges include the transfer of malaria, HIV/AIDS, TBL
programmes to the State Primary Health Care Boards (SPHCBs), and transformation of LGA
PHC departments into Local Government Health Authorities (LGHAs) with clear reporting line
to the SPHCB. While the latter has seen some improvement, the NPHCDA has advised
respective MDAs to provide desk officers in the SPHCBs to bridge operational and
programmatic gaps. This has informed a considerable improvement in the pillar performance.
Thirteen (35%) states namely Abia, Adamawa, Delta, Gombe, Kano, Kebbi, Niger, Ondo,

7
Osun, Plateau, Sokoto, Yobe and Zamfara have attained full Repositioning. Adamawa, Delta
and Yobe states achieved full repositioning since Scorecard 4 assessment.

3.2. PHCUOR Scorecard 6 Results by Geopolitical Zones

Zonal PHCUOR Scorecard 6 Results

100%
90%
90% 86%
81%
80% 76% 76%
70% 71%
70% 65%
60%
50%
40%
30%
20%
10%
0%
South East South West South North East North West North Natl. Avg. Exp. Target
South Central

Figure 3: Average performance across geopolitical zones

North-West and North-East zones recorded the highest scores at 86% and 81% respectively.
South-South had the lowest score at 65%. None of the six (6) zones attained the expected
target of 90%.

It is important to note that while South-East was one of the highest performing zones in
scorecard 5, it declined by 4% in Scorecard 6. Also, South-West recorded a decline of 2%,
while South-South remained the same at 65%

In terms of comparative strength, the North-West recorded the best performance in five of the
pillars (Governance & Ownership, Legislation, Repositioning, Systems Development, Human
Resources). It also recorded the best performance in the Funding Sources pillar alongside
South-West. Other zones that recorded best performance in MSP, Operational guidelines and
Office Setup are South-East, North-East and North Central respectively. This provides a
background for peer-to-peer learning and experience sharing.

8
3.3. State PHCUOR Scorecard 6 Results

PHCUOR RESULTS: 36 STATES + FCT

100%

99%

99%
98%

98%
98%

96%

96%
95%

95%
91%

90%

90%
88%

87%
87%
85%
84%
83%
82%

82%

81%
80%
79%
77%

76%
72%
65%
63%

57%

55%
54%

49%
49%
47%

42%
39%
38%

26%
Ekiti

Zamfara
Katsina
Gombe
Imo
Anambra

Delta

Osun
Abia

Bayelsa

Lagos

Sokoto
Borno

FCT, Abuja

Kano

Yobe
Kaduna

Kogi

Oyo

Taraba
Edo
Bauchi

Benue

Cross River

Ebonyi

Enugu

Plateau
Adamawa

Kwara

Ogun
Ondo

Natl. Avg.
Akwa Ibom

Niger
Jigawa

Kebbi

Nasarawa

Rivers

Exp. Target
Figure 4: Average performance across states in percentage.

All states have established their State Primary Health Care Boards (SPHCBs), although at
varied levels of PHCUOR implementation. Thirty (11) percent of the states surpassed the
expected target of 90%. Abia state recorded the highest score nationwide at 100%, followed
by Niger and Plateau states at 99%. However, Ogun state recorded the lowest score at 26%,
followed by Akwa-Ibom and Kwara states at 38% and 39% respectively.

Table 2: Illustration of states’ PHCUOR performance. Green: Good; Yellow: Fair; Red: Poor

States Performance SC5 Performance SC6

Abia

Anambra

Ebonyi

Enugu

Imo

Adamawa

Bauchi

9
Borno

Gombe

Taraba

Yobe

Benue

FCT

Kogi

Kwara

Nasarawa

Niger

Plateau

Jigawa

Kaduna

Kano

Katsina

Kebbi

Sokoto

Zamfara

10
 Ekiti

Lagos

Ogun

Ondo

Osun

Oyo

Akwa Ibom

Bayelsa

Cross River

Delta

Edo

Rivers

Legend

90 – 100

50 – 89

0 – 49

A comparative analysis of Scorecard 6 states’ performance with that of Scorecard 5 shows

that, 62% of states recorded significant performance: Plateau state recorded the highest
performance increase at 36%. Other states with significant performance increase are Borno
(28%); Zamfara (22%); Lagos (17%); Kebbi, Cross-River and Imo (16%); Ondo (15%); Katsina
(12%); Enugu (11%); Bauchi, Delta, Edo, Gombe, Kano (9%); Kaduna (6%); Abia, FCT, Niger
(5%); Kwara (4%); Rivers (3%); Nasarawa (2%); Akwa-Ibom (1%). Two states (Ekiti and
Taraba) maintained same performance. While 32% (12) of states recorded an average decline
11
of 14%: Adamawa (-5%), Anambra (-9%), Bayelsa (-17%), Benue (-19%), Ebonyi (-13%),
Jigawa (-37%; highest decline), Kogi (-18%), Ogun (-14%), Osun (-10%), Oyo (-10%), Sokoto
(-9%), Yobe (-1%).

It is unclear if there are any neighbourhood effects in states’ performance. However, some
identified determinants of performance are:

• Political will
• Level of SPHCB autonomy
• Capacity of the SPHCB leadership (both Governing Board and Management Team)
• Presence of implementing partners (IPs); most states with high presence of
implementing partners (IPs) leverage technical and financial assistance of the IPs to
establish the PHCUOR Institutional framework

Gaps

Some of the identified gaps in Scorecard 6 assessment include:

• Non-availability of key strategy documents such as MSP, investment plan, annual

operational plan, budget, M&E framework, PHCUOR implementation guidelines,
operational guidelines at the sub-state levels
• Limited awareness of the above strategy documents at the sub-state levels

Assessing Health Outcome

The Scorecard 6 assessment had a component on PHC service delivery outcomes. It

measured eight metrics namely: HMIS facility reporting rates (>80%), decreasing trend in the
number of institutional maternal deaths, decreasing trend in the number of institutional still
births, decreasing trends in the number of institutional neonatal, decreasing trends in the
number of institutional under five deaths, decreasing trends in the number of institutional under
five children that are underweight, increasing trend in contraceptive use, decreasing trend in
the number of zero dose.

Data for the preceding 12 months were pulled from DHIS2 to measure the metrics. Each metric
had a score of one (if in the affirmative – ‘Yes’) totalling 8 i.e. (10%). 54% (20) percent of the
states recorded 100% performance; twelve states (32%) had more than 50% performance,
while the other states except Kogi and Bayelsa (13%) performed fairly (up to 50%).

12
 STATE PERFORMANCE BY SERVICE
DELIVERY OUTCOMES

100%

100%
100%

100%

100%
100%

100%

100%

100%

100%

100%
100%
100%

100%

100%
100%
100%
100%
100%
100%
88%
88%

88%
88%

88%
88%

88%

88%

88%

88%
75%

63%
50%

50%
38%

13%

13%
Adamawa

Imo
Anambra

Enugu

Kwara

Yobe
Jigawa

Niger
Ogun
Kaduna

Kogi

Zamfara
Benue
Borno

Edo

Nasarawa

Plateau
Gombe

Kano

Lagos

Osun
Kebbi

Sokoto
Taraba
Abia

Ebonyi

Ondo

Oyo
Bauchi
Bayelsa

Ekiti
Akwa Ibom

Cross River

FCT, Abuja
Delta

Katsina

Rivers
Figure 5: Performance by Service Delivery Outcomes in Percentage.

Cross-Cutting Issues across the States

Below are cross cutting issues with the establishment of PHCUOR institutional framework in
the states.

Table 3: Cross-cutting issues

PILLARS ISSUES

GOVERNANCE Non-availability of governing board

AND
OWNERSHIP Inappropriate board member representation

Unclear roles between the governing board and the management team

LEGISLATION Non-availability of clear oversight function by the SMoH including

accountability lines in the SPHCB Law

Non-inclusion of part-time role for Governing Board in the SPHCB Bill

Non-availability of legal provision for formation/activation of ward

development committees

Non-availability of regulations for the operationalization of the SPHCB

Law

13
 MINIMUM Non-availability of costed MSP
SERVICE
PACKAGE (MSP) Non-availability of investment plan

No provision for investment plan in the state annual budget

REPOSITIONING Minimal provision of malaria, HIV/AIDS, TBL desk officers in the

SPHCBs

Non-transformation of LGA PHC departments into Local Government

Health Authorities (LGHAs) with reporting lines to SPHCB

SYSTEMS Non-availability of MSP and investment plan in the State Strategic

DEVELOPMENT Health Development Plan (SSHDP)

Non-incorporation of LGHA AOPs in SPHCB AOP and budget

Non-availability of LGHA AOPs in the LGHAs

OPERATIONAL Non-availability of SPHCB Operational Guidelines for administrative

GUIDELINES procedures (HR, Admin, Logistics, Finance & Accounts, Procurement
etc.)

Non-availability of orientation for key personnel (management team of

SPHCB and LGHAs) on the mandate, mission and vision of the SPHCB

OFFICE SET UP Limited availability of an independent, clearly signposted, equipped and

permanent office building for the LGHAs

Recommendations

NPHCDA

• Continue providing support to state on MSP, Repositioning and Legislation pillars:

o Legislation: facilitate amendment of laws to include critical components of the
PHCUOR policy
o Repositioning: actively facilitate the availability of desk officers for malaria,
HIV/AIDS, TBL and other programmes in the SPHCB
o MSP: support States to develop their MSP with the necessary complements
and widely disseminate the MSP beyond the SPHCB
• Provide targeted support to Akwa-Ibom, Ogun, Kogi, and Kwara State Primary Health
Care Boards to improve performance
• Increase awareness and accessibility of the TSU peer learning platform
• Encourage and assist high performing states (Abia, Plateau, Niger) to provide peer
mentoring for states within their zones and beyond
14
States

• Akwa-Ibom, Ogun, Kogi, and Kwara states to actively seek and leverage the TSU peer
learning platform to improve on the identified weak areas
• Abia, Adamawa States (states with full repositioning) to peer mentor other states to
fully reposition all PHC elements to the SPHCB
• Other states to be supported to achieve full repositioning

LGHAs

• Develop and incorporate LGA level AOP, M&E results/performance framework into
state level document
• Track implementation progress of AOP and M&E performance framework
• Contribute to creating awareness and improving the knowledge on the PHCUOR
implementation guidelines, and other PHC related strategic documents at the sub-
state level
• Facilitate LGA PHC budget performance

Partners

• Provide technical and financial assistance to states, particularly states with poor
performance, to fully establish PHCUOR institutional framework and begin
implementation

15
3.4. STATE PERFORMANCE BY ZONES

3.4.1.

Overview of South-East Performance

The South-East had an average score of 76%. This is a -4% decline from the Scorecard
5assessment. The best performing pillar in the zone was Legislation (91%) followed by
Governance & Ownership (89%), while the least performing pillar was Repositioning (53%).
The Repositioning pillar has remained the least performing pillar in the zone since 2019
(Scorecard 5).

SOUTH EAST SCORECARD 6 PERFORMANCE

Abia Anambra Ebonyi Enugu Imo
100%

100%
100%
100%
100%

100%

100%

100%
100%

100%

100%

100%

100%

100%
100%
100%

100%

100%
92%
91%
89%

86%
86%

86%
86%
86%
75%

75%
67%

67%

67%
64%

58%

57%
56%

56%

56%

50%
43%
33%

33%
29%
22%
11%

0%

Figure 6: Performance of the South-East zone.

Abia and Enugu States were the best performing states and the only states in the zone that
surpassed the 90% expected target. They can provide peer mentoring to other states. Imo
state recorded the lowest score in the zone with huge challenge in Repositioning, Human
Resources, Funding Sources & Structure and Operational Guidelines pillars. Ebonyi state,
although the third best state in the zone based on overall performance, requires support to
improve in the Repositioning pillar where performance was poor (33%).

16
 Imo
States

Abia

0 – 49
Enugu
Ebonyi

50 – 89
Legend
90 – 100
Anambra

47
90
79
63
100
Overall scores
(%)

Governance &
Ownership
Table 4: Performance by states

Legislation

MSP

Repositioning

Systems
Development

Human
Resources

Funding
Sources &
Structure
Operational
Guidelines

Office Setup

17
 ABIA STATE SCORECARD 6 RESULT
120%
100% 100% 100% 100% 100% 100% 100% 100% 100%
100% 90%
76%
80%
60%
40%
20%
0%

Figure 7: Abia State Scorecard 6 scores

Abia State scored 100% in the PHCUOR Scorecard 6 assessment placing it in the 1st position
nationwide.

Abia State was created out of Imo state in 1991. It has a land mass of 5,243 sq. km with
projected population of 3,727,300 by 2016 (NPC 2006). It has 17 Local Government Areas
(LGAs). There are 615 health facilities in the State: 518 (84%) are PHC facilities and 96 (16%)
are SHC facilities. Ninety-three (481) percent of the PHC facilities are public health facilities
while 7% (37) are private health facilities.

The Abia State Primary Health Care Board was established on 25th September 2017. The
state is implementing the Basic Health Care Provision Fund (BHCPF). The BHCPF eligible
health facilities receive monthly funds as direct facility financing (DFF) to run operational
expenses. The facilities are also enrolled under the National Health Insurance Scheme to
provide free health services to vulnerable populations. The state’s skilled birth attendance
(SBA) is at 89%, and ANC 4+ visits at 82% (MICS 2021); while under five mortality rate is at
86/1000 (NDHS,2018).

18
 ANAMBRA STATE SCORECARD 6 RESULT
120%
100%
100% 91% 86% 90%
76%
80% 67%
58% 56% 57% 56%
60%
40%
20%
0%
0%

Figure 8: Anambra State Scorecard 6 scores

Anambra State scored 63% in the PHCUOR Scorecard 6 assessment placing it in the 27 th
position nationwide. The Governance & Ownership (100%) and Legislation (91%) pillars
surpassed the 90% target. While other pillars such as MSP, Repositioning, Systems
Development, Human Resources, need to be strengthened, the Office Set-up pillar requires
immediate attention as it is the worst performing at 0%.

Anambra State was created in 1991 with a land mass of 4,844 sq. km and a projected
population of 5,527,800 by 2016 (NPC 2006). It has 21 Local Government Areas (LGAs). The
state has 1,485 health facilities: 1,360 (92%) are PHC facilities. Twenty-nine (392) percent of
the PHC facilities are public health facilities and 71% (968) are private health facilities
(NPHCDA 2015).

The Anambra State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 96%, and ANC 4+ visits at 93% (MICS 2021);
while under five mortality rate is at 58/1000 (NDHS,2018).

19
Table 5 Components to Improve for Anambra State

Pillars Specific Areas to Improve

• Develop Regulations to operationalize the SPHCB Law

Legislation:
91%

• Develop investment plan based on the gap analysis

MSP: 58% • Cost the developed MSP document and investment plan to reflect
state fiscal space for all PHC facilities in the State
• Develop documentation on gap analysis between the proposed HRH,
Infrastructure, equipment and services approved in the MSP
document and what is currently on ground
• Incorporate investment plan in annual budget to address
infrastructural and HRH gaps required to meet the MSP for PHC
facilities
• Approve costed MSP and disseminate to all key stakeholders

• Transfer PHC department and staff from the SMoH to SPHCB

Repositioning: • Transfer all RMNCAEH+N programs to the SPHCB
• Ensure availability of TBL programme focal person in the SPHCB
56% • Conduct orientation and reorientation of LGHAs staff on the roles and
responsibilities of the SPHCB, LGAs and LGHAs
• Develop PHC AOPs for all LGHAs in the state
Systems • Develop state PHC Annual Operational Plan (AOP) with budget and
Development: incorporate LGA PHC Annual Operational Plans
67% • Develop M&E /results/performance framework with clear milestones
and targets for the SPHCB
• Create a distinct unit/department for HRH in the SPHCB
Human • Develop a job description for every position in the SPHCB, LGHAs
resources: and facilities
56% • Institutionalise a process for onboarding new staff of the SPHCB

• Establish a system to regularly track PHC income and expenditure

Funding
Sources &
Structure:
86%

• Disseminate PHCUOR Implementation Guidelines to all staff of

Operational SPHCB and LGHAs
Guidelines:
67%

Office Setup: • Ensure that the SPHCB, LGHAs have an independent, clearly
0% signposted, and permanent office building
• Ensure that the offices have at least internet access, computers,
printers, portable water, power and power backup

20
 EBONYI STATE SCORECARD 6 RESULT
120% 100% 100% 100%
100% 86% 86% 90%
75% 76%
80% 67%
60%
40%
20%
0%

Figure 7: Ebonyi State Scorecard 6 scores

Ebonyi State scored 79% in the PHCUOR Scorecard 6 assessment placing it in the 23rd
position nationwide. The Legislation, MSP and Operational Guidelines Pillars performed the
highest at 100%. The Repositioning, Office Set up and Human Resources pillars require
immediate attention for improvement.

Ebonyi State was created out of Enugu & Abia states in 1996, and its capital is Abakaliki. It
has a land mass of 5,935 sq. km with projected population of 2,880,400 by 2016 (NPC 2006).
It has 13 Local Government Areas (LGAs); 567 health facilities: 516 (91%) are PHC facilities.
Seventy-four (383) percent of the PHC facilities are public health facilities and 26% (133) are
private health facilities.

The Ebonyi State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 94%, and ANC 4+ visits at 79% (MICS 2021); while
under five mortality rate is at 91/1000 (NDHS,2018).

21
Table 6: Components to Improve for Ebonyi State

Pillars Established Criteria

Governance & • Ensure optimal functionality of the Governing Board including statutory
Ownership: meetings (quarterly, bi-annual meetings)
89%

• Transfer PHC department and staff from the SMoH to SPHCB

Repositioning • Transfer PHC department and all PHC staff in the State Ministry of
33% Local Government (SMoLG) to the SPHCB; and convert them to
LGHAs
• Ensure availability of TBL, Malaria, HIV/AIDs programme focal persons
in the SPHCB

• Conduct orientation and reorientation of LGHAs staff on the roles and

responsibilities of the SPHCB, LGAs and LGHAs

Systems • Develop Integrated Supportive Supervision (ISS) plan for the SPHCB,
Development: and ensure its functionality
86%

Human • Ensure availability of a functional Human Resources Information

resources: System (HRIS) for Human Resources for Health (HRH) Planning in the
67% SPHCB
• Engage/recruit (or recruited by transfer or secondment) requisite
number of staff to fill identified HRH gaps at State and LGHAs levels
• Institutionalize a process to onboard new staff of the SPHCB

Funding • Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Sources & SPHCB
Structure:
86%

Office Setup: • Provide internet access, computers, printers, portable water, power,
50% power backup and for each of the management team - office space,
basic furniture, computers and printers in the state and LGHA offices

22
 ENUGU STATE SCORECARD 6 RESULT
120%
100% 100% 100% 100% 100%
100% 86% 86% 90%
75% 76%
80% 67%
60%
40%
20%
0%

Figure 8: Enugu State Scorecard 6 scores

Enugu State scored 90% in the PHCUOR Scorecard 6 assessment placing it in the 12th
position nationwide. The state’s best performing pillars are Governance & Ownership,
Legislation, Human Resources, Operational Guidelines and Office Setup.

Enugu State has a land mass of 7,161 sq. km with projected population of 4,411,100 by 2016
(NPC 2006). It’s capital is Enugu, and has 17 Local Government Areas (LGAs); 868 health
facilities in the State: 524 (60%) are PHC facilities and 342 (39%) are SHC facilities. Thirty-
seven (322) percent of the PHC facilities are public health facilities and 63% (549) are private
health facilities.

The Enugu State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 96%, and ANC 4+ visits at 85% (MICS 2021); while
under five mortality rate is at 61/1000 (NDHS,2018).

23
Table 7: Components to Improve for Enugu State

Pillars Established Criteria

• Cost the developed MSP document and investment plan to reflect

MSP: 75% state fiscal space for all PHC facilities in the State
• Approve costed MSP and disseminate to all key stakeholders
• Ensure availability of TBL, Malaria, HIV/AIDS programme focal
Repositioning: persons in the SPHCB

67%

• Conduct periodic SPHCB-wide quarterly performance review involving

Systems stakeholders from the SPHCB/LGHA/HF
Development:
86%

• Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Funding SPHCB
Sources &
Structure:
86%

24
 IMO STATE SCORECARD 6 RESULTS
100% 92% 90%
90% 75% 76%
80%
70% 64%
56%
60%
50% 43%
40% 29% 33%
30% 22%
20% 11%
10%
0%

Figure 9: Imo State Scorecard 6 scores

Imo State scored 47% in the PHCUOR Scorecard 6 assessment placing it in the 33rd position
nationwide. The state’s best performing pillar is MSP at 92%; immediate attention is required
on Repositioning, Systems Development, HR, Funding Sources, Operational Guidelines
pillars.

Imo State was created in 1976. It has a land mass of 5,530 sq. km with projected population
of 5,408,800 by 2016 (NPC 2006). Its capital is Owerri, it has 27 LGAs; 1,337 health facilities
in the State: 805 (60%) are PHC facilities and 530 (40%) are SHC facilities. Fifty-two (416)
percent of the PHC facilities are public health facilities and 48% (389) are private health
facilities (NPHCDA 2015).

The Imo State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 97%, and ANC 4+ visits at 96% (MICS 2021); while
under five mortality rate is at 87/1000 (NDHS,2018).

25
Table 8: Components to Improve for Imo State

Pillars Established Criteria

• Establish LGHAs with a management team in all LGAs with direct

Governance & reporting line to the SPHCB
Ownership: • Establish Local Government Advisory Committee in all LGAs; LGAC
56% to be headed by the local government Chairman
• Establish a functional Facility Management Committee (FMC) in each
of the ward focal Primary Health Centres in the State
• Amend the SPHCB Law to incorporate:
Legislation: o Clear provision on the oversight role of the SMoH including
64% reporting line from the ES SPHCB to Commissioner for Health
o Movement of PHC departments, PHC staff, PHC programmes
and PHC funds in all LGAs in the State to the LGHAs and
SPHCB
o Clear provision for the development of a costed and approved
Minimum Service Package (MSP) document for service
delivery in all PHC facilities in the State
o Clear provisions for the different sources of funding and
expected contributions of the State and LGAs to the SPHCB
• Ensure availability of at least one fully functional PHC in every ward in
MSP: 92% the state (PHC facility operates 24hrs service, with requisite human
resources, electricity, water supply)
• Transfer all PHC department and staff in the State Ministry of Health
Repositioning: (SMoH) to the SPHCB
• Transfer all RMNCAEH+N programmes to the SPHCB
11% • Ensure availability of TBL, Malaria, HIV/AIDs programme focal
persons in the SPHCB
• Institutionalize a system to periodically conduct orientation and
reorientation for SPHCB staff (including those in the LGHAs) on the
roles and responsibilities of the SPHCB, LGAs and LGHAs
• Develop PHC AOPs for all LGHAs in the state
Systems • Develop state PHC Annual Operational Plan (AOP) with budget and
Development: incorporate LGA PHC Annual Operational Plans
43% • Develop M&E /results/performance framework with clear milestones
and targets for the SPHCB
• Establish a functional data quality assurance system

Human • Develop job description for every position in the LGHAs, health
Resources: facility management team
22% • Update SPHCB nominal roll with the names of all SPHCB and
LGHAs staff
• Ensure availability of a functional Human Resources Information
System (HRIS) for Human Resources for Health (HRH) Planning in
the SPHCB
• Conduct HRH assessment, and develop a HRH plan to fill identified
personnel gaps at the SPHCB and LGHAs

26
 • Engage/recruit (or recruited by transfer or secondment) requisite
number of staff to fill identified HRH gaps at State and LGHAs levels
• Institutionalize a process to onboard new staff of the SPHCB

• Establish a dedicated budget line for PHC implementation in the

Funding approved annual State budget
Sources & • Establish a dedicated budget line for PHC implementation in the
Structure: approved annual LGA budget
29% • Ensure all PHC staff are on the SPHCB payroll
• Establish a functional system for regular tracking of PHC income and
expenditure
• Ensure that all LGHA have a dedicated bank account with signatories
from the LGHA management team
• Publish consolidated audited report of PHC income and expenditure
for the preceding year
• Disseminate the PHCUOR Implementation Guidelines to all staff at
Operational SPHCB and LGHAs
Guidelines: • Conduct orientation for SPHCB personnel (management team of
33% SPHCB and LGHAs) on mandate, mission, vision and new/emerging
PHC issues using the SPHCB Operational Guidelines
• Ensure that the SPHCB has an independent office space, with
Office Setup: computers, printers for the individual management team
75%

27
3.4.2.

Overview of South-South Performance

South-South had an average score of 65%, same as in Scorecard 5. The best performing pillar
in the zone was Funding Sources (89%) followed by Repositioning (87%), while the least
performing pillar was MSP (35%). In the zone, only Delta state surpassed the 90% target.
Delta State was the best performing state at 86%.

Delta State was the best performing and the only state in the zone that surpassed the 90%
expected target. Delta state can provide peer mentoring to other states.

SOUTH SOUTH
Akwa Ibom Bayelsa Cross River Delta Edo Rivers
100%

100%
100%

100%

100%

100%
100%

100%
100%
100%

100%

100%

100%
92%
91%
91%

89%
89%
89%

86%
86%
86%
86%
83%

75%
75%

75%
75%
73%

71%
67%

67%

67%

67%
67%

67%
67%
67%
57%
57%
56%
56%

55%

44%

43%
33%

33%

25%
14%
0%

0%
0%

0%
0%

Figure 12: Performance of the South-South zone.

28
 States

Edo
Ibom

River

Delta
Cross

0 – 49
Akwa-

Rivers

50 – 89
Legend:
90 – 100
81
77
95
65
Bayelsa 57
38
Overall scores
(%)

Governance &
Ownership

Legislation

MSP

Repositioning
Table 9: Performance of the South-South States

System
Development

Human
Resources

Funding
Sources
&Structure
Operational
Guidelines

Office Setup

29
AKWAIBOM STATE
38%
AKWAIBOM STATE SCORES
100% 90%
90% 75% 76%
80% 67% 67%
70%
60% 44%
50% 43%
40% 33%
30% 14%
20%
10% 0% 0%
0%

Figure 10: Akwa Ibom State Scorecard 6 scores

Akwa-Ibom State scored 38% in the PHCUOR Scorecard 6 assessment placing it in the 36th
position nationwide. Office Set up is the best performing pillar at 75%. Immediate attention is
required in the Legislation, MSP, Systems Development, Operational Guidelines pillars.

Akwa-Ibom State was created in 1987. It has a land mass of 7,249 sq. km with projected
population of 5,482,200 as at 2016 (NPC 2006). Its capital is Uyo. It has 31 LGAs, 543 health
facilities: 355 (65%) are PHC facilities (NPHCDA 2015).

The Akwa-Ibom State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 81%, and ANC 4+ visits at 82% (MICS 2021);
while under five mortality rate is at 98/1000 (NDHS,2018).

30
Table 5: Components to Improve for Akwa Ibom State

Pillars Established Criteria

• Ensure that the Governing Board has clear roles and responsibilities
Governance & separate from that of the management team
Ownership: • Ensure that the Governing Board includes representatives from
67% SMoH, SMoLG, ALGON, Women Group
• Ensure that the Governing Board meet periodically (quarterly,
biannually), and receive seating allowance - not salaries

• Ensure that the SPHCB Law is amended to incorporate:

Legislation: o Provisions for the different sources of funding and expected
0% contributions of the State and LGAs to the SPHCB
o Part time role of the Governing Board
o Clear delineation of roles of the Governing Board from that of
the management team
o Transformation of LGA PHC departments to LGHAs with clear
reporting line to the SPHCB
o Formation/reactivation of ward development committees
o The oversight role of the SMoH including accountability lines
o Transfer of PHC departments, PHC staff, PHC programmes
and PHC funds in all LGAs and MDAs in the state to the LGHAs
and SPHCB accordingly
o Transfer of all PHC facilities in the state to the SPHCB
o Development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o Recruitment and management of human resources in line with
the PHCUOR principles
• Ensure that the amended bill is signed into Law by the Executive
Governor and gazetted
• Develop Regulations for operationalization of the law

• Develop, cost and approve (by the Governor) a minimum service

MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services,
resources (HRH, infrastructure, equipment and commodities)
expected at each facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for
primary health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders

31
 • Transfer all RMNCAEH+N programmes to the SPHCB
Repositioning: • Ensure availability of TBL, Malaria, HIV/AIDs programme focal
persons in the SPHCB
44% • Institutionalize a system to periodically conduct orientation and
reorientation for SPHCB staff (including those in the LGHAs) on the
roles and responsibilities of the SPHCB, LGAs and LGHAs
• Develop strategic health development plan and incorporate MSP
Systems and investment plan
Development: • Develop state PHC Annual Operational Plan (AOP) with budget
14% incorporating all LGHA annual operational plans
• Ensure that all LGHAs have PHC AOP
• Develop M&E/result/performance framework with clear milestones
and targets for the SPHCB
• Establish a functional Integrated Supportive Supervision (ISS) plan
for the SPHCB
• Establish a functional performance review system in place for the
SPHCB AOP across all levels (state, LGA. Facility)
• Establish a functional data quality assurance system

• Develop job description for every position in the LGHA and facilities
Human • Ensure availability of a functional Human Resources Information
resources: System (HRIS) for Human Resources for Health (HRH) Planning in
67% the SPHCB
• Engage (or recruit by transfer or secondment) required staff to fill
identified HRH gaps at state and LGHA levels
• Institutionalise a process for onboarding new staff of the SPHCB
• Ensure that there is a dedicated budget line for PHC implementation
Funding in approved LGA budgets
source & • Ensure all PHC staff are on the SPHCB payroll
structure: • Institutionalize a system to regularly track PHC income and
43% expenditure
• Publish consolidated audited report of PHC income and expenditure
for the preceding year
• Disseminate PHCUOR implementation guidelines to all staff at the
Operational SPHCB and LGHAs
guidelines: • Conduct orientation for SPHCB staff on the vision, mission,
33% mandate of the SPHCB using the SPHCB operational guidelines

• Ensure all LGHAs have independent, clearly signposted and

Office Setup: permanent office building
75%

32
BAYELSA STATE
57%
BAYELSA PHCUOR SCORECARD 6 SCORES
100% 86% 90%
90% 75% 76%
80% 73%
67% 67%
70% 56% 57%
60%
50%
40% 33%
30%
20%
10% 0%
0%

Figure 11: Bayelsa State Scorecard 6 scores

Bayelsa State scored 57% in the PHCUOR Scorecard 6 assessment placing it in the 28th
position nationwide. None of its pillars surpassed the 90% target. The best performing pillar is
Funding Sources followed by Office Set up and Legislation, while MSP was the least
performing pillar at 0%.

Bayelsa State was created in 1996 from parts of Rivers State. It has a land mass of 10,773
sq. km with projected population of 2,278,000 as at 2016 (NPC 2006). Its capital is Yenagoa
has eight LGAs and 232 health facilities in the State: 172 (74%) are PHC facilities and 59
(25%) are SHC facilities. All the PHC facilities are public facilities (NPHCDA 2015).

The Bayelsa State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 59%, and ANC 4+ visits at 51% (MICS 2021);
while under five mortality rate is at 31/1000 (NDHS,2018).

33
Table 6: Components to Improve for Bayelsa State

Pillars Established Criteria

• Ensure that a management team headed by a substantive

Governance & Executive Secretary is in place in the SPHCB
Ownership: 56% • Ensure that the Governing Board has clear roles and
responsibilities separate from that of the management team
• Ensure that the governing board has the necessary
representation across all the groups including women group,
ALGON, SMoLG, SMoH
• Ensure that the Governing Board meets quarterly or biannually
• Establish Local Government Advisory Committee to be headed
by the Local Government Chairman
• Amend SPHCB law to:
Legislation: 73% o Have clear provision for the development of a costed and
approved Minimum Service Package (MSP) document for
service delivery in all PHC facilities in the State
o Have clear provisions for the different sources of funding
and expected contributions of the State and LGAs
• Develop Regulations for the operationalization of the SPHCB
Law
• Develop, cost and approve (by the Governor) a minimum service
MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology
of PHC facilities in the state
• Ensure the MSP document defines the minimum services,
resources (HRH, infrastructure, equipment and commodities)
expected at each facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for
primary health care delivery
• Develop an investment plan (based on the gap analysis above)
to guide the annual funding for implementing the minimum
service package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance
of the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Ensure availability of TBL, Malaria, HIV/AIDs programme focal
Repositioning:67% persons in the SPHCB
• Institutionalize a system to periodically conduct orientation and
reorientation for SPHCB staff (including those in the LGHAs) on
the roles and responsibilities of the SPHCB, LGAs and LGHAs
• Develop strategic health development plan and incorporate MSP
Systems and investment plan
Development: • Ensure that all LGHAs have PHC AOP
57% • Ensure availability of a functional data quality assurance system
in the SPHCB

34
 • Develop job description for every position in the SPHCB
Human resources: including LGHAs, health facility management team
33% • Ensure availability of a functional Human Resources Information
System (HRIS) for Human Resources for Health (HRH) Planning
in the SPHCB
• Conduct HRH needs assessment and develop a Human
Resources for Health (HRH) Plan to fill identified HRH gaps at
the SPHCB and LGHA
• Engage (or recruit by transfer or secondment) required staff to
fill identified HRH gaps at state and LGHA levels
• Institutionalise a process for onboarding new staff of the SPHCB
• Ensure that there is a dedicated budget line for PHC
Funding Sources implementation in approved annual State and LGA budget
& Structure: 86%

• Conduct orientation for SPHCB staff on the vision, mission,

Operational mandate of the SPHCB using the SPHCB operational guidelines
Guidelines: 67%

Office Setup: 75%

• Ensure all LGHAs have independent, clearly signposted and
permanent office building

35
CROSS RIVER STATE
65%
CROSS RIVER SCORECARD 6 SCORES
100% 89% 86% 90%
90% 83%
76%
80% 67% 67%
70% 57%
56% 55%
60%
50%
40%
25%
30%
20%
10%
0%

Figure 12: Cross River State Scorecard 6 scores

Cross River State scored 65% in the PHCUOR Scorecard 6 assessment placing it in the 26 th
position nationwide. None of the pillars attained the 90% expected target. Its best performing
pillar is Repositioning followed by Funding Sources and MSP. The least performing pillar is
Office Setup (25%).

Cross River State was created in 1967. It has a land mass of 20,156 sq. km with projected
population of 3,866,300 as at 2016 (NPC 2006). Its capital is Calabar, it has 18 Local
Government Areas (LGAs), 734 health facilities in the State: 593 (81%) are PHC facilities and
139 (19%) are SHC facilities. Ninety-seven (575) percent of the PHC facilities are public health
facilities while 3% (18) are private health facilities.

The Cross River State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 84%, and ANC 4+ visits at 80% (MICS 2021);
while under five mortality rate is at 80/1000 (NDHS,2018).

36
Table 7: Components to Improve for Cross River State

Pillars Established Criteria

• Constitute a management team headed by a substantive

Governance & Executive Secretary in the SPHCB
Ownership: 56% • Ensure that the governing board has the necessary representation
across all the groups including women group, ALGON, SMoLG,
SMoH
• Ensure that the Governing Board meets quarterly or biannually
• Constitute and inaugurate SPHCB governing board with
necessary representation of all groups
• Ensure ward development committees across the state are
functional
• Amend SPHCB Law to:
Legislation: 55% o Make provision for the formation/reactivation of Ward
Development Committees
o Reflect clear oversight function of the SMoH on the
SPHCB
o Make provision for the development of a costed and
approved Minimum Service Package (MSP) document for
service delivery in all PHC facilities in the State
o Make provision for the recruitment and management of
human resources in line with the PHCUOR principles
• Develop regulations for the operationalisation of the law
• Develop an investment plan (based on the gap analysis above) to
MSP: 83% guide the annual funding for implementing the minimum service
package for PHC facilities in the State
• Make provision in the current annual budget for the investment
plan

Repositioning: • Institutionalize a system to periodically conduct orientation and

reorientation for SPHCB staff (including those in the LGHAs) on
89% the roles and responsibilities of the SPHCB, LGAs and LGHAs

• Develop strategic health development plan and incorporate MSP

Systems and investment plan
Development: • Ensure that all LGHAs have PHC AOP
57% • Develop state PHC Annual Operational Plan (AOP) with budget
incorporating all LGHA annual operational plans
• Develop job descriptions for every position in the LGHAs, facilities
Human management team
Resources: 67% • Ensure availability of a functional Human Resources Information
System (HRIS) for Human Resources for Health (HRH) Planning
in the SPHCB
• Institutionalise a process for onboarding new SPHCB staff
• Publish consolidated audited report of PHC income and
Funding Sources expenditure for the preceding year
& Structure: 86%

37
 • Conduct SPHCB-wide orientation to familiarise staff at all levels
Operational with the mandate, vision, mission of the SPHCB
Guidelines: 67%

• Ensure the SPHCB and all LGHAs have respective independent,

Office Setup: clearly sign posted and permanent office building
25% • Ensure that the office building have at least internet access,
computers, printers, portable water, power and power backup

38
DELTA STATE
95%
DELTA SCORECARD 6 RESULTS
120% 100% 100% 100% 100% 100% 100%
100% 92% 86% 90%
75% 76%
80%
60%
40%
20%
0%

Figure 13: Delta State Scorecard 6 scores

Delta State scored 95% in the PHCUOR Scorecard 6 assessment placing it in the 9th position
nationwide. Six out of the nine pillars surpassed the 90% expected target, recording a 100%
performance. The least performing pillar is Office Setup at 75%.

Delta State was created in 1991. It has a land mass of 17,698 sq. km with projected population
of 5,663,400 by 2016 (NPC 2006). Its capital is Asaba, it has 25 Local Government Areas
(LGAs), 908 health facilities in the State: 804 (89%) are PHC facilities and 102 (11%) are SHC
facilities. Fifty-three (437) percent of the PHC facilities are public health facilities while 47%
(383) are private health facilities.

The Delta State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 83%, and ANC 4+ visits at 77% (MICS 2021); while
under five mortality rate is at 53/1000 (NDHS,2018).

Table 8: Components to Improve for Delta State

Pillars Established Criteria

MSP: 92% • Disseminate the MSP document to all stakeholders

Funding • Ensure that all PHC staff (State and LGHAs) are on the payroll of
Sources & the SPHCB
Structure: 86%
Office Setup: • Ensure that each LGHA has an independent, clearly sign posted and
75% permanent office building

39
EDO STATE
77%
EDO SCORECARD 6 RESULTS
120%
100% 100% 100%
100% 91% 89% 90%
71% 75% 76%
80% 67%
60%
40%
20%
0%
0%

Figure 14: Edo State Scorecard 6 scores

Edo State scored 77% in the PHCUOR Scorecard 6 assessment placing it in the 24th position
nationwide. Four out of the nine pillars surpassed the 90% target. The least performing pillar
is MSP at 0%.

Edo State was created in 1991. It has a land mass of 19,187 sq. km with projected population
of 4,235,600 by 2016 (NPC 2006). Its capital is Benin, it has 18 Local Government Areas
(LGAs), 724 health facilities in the State: 672 (93%) are PHC facilities and 46 (6%) are SHC
facilities. Fifty-two (380) percent of the PHC facilities are public health facilities while 48%
(292) are private health facilities (NPHCDA 2015).

The Edo State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 91%, and ANC 4+ visits at 75% (MICS 2021); while
under five mortality rate is at 71/1000 (NDHS,2018).

Table 9: Components to Improve for Edo State

Pillars Established Criteria

• Amend SPHCB Law to:

Legislation: o Make provision for the development of a costed and approved
91% Minimum Service Package (MSP) document for service
delivery in all PHC facilities in the State

• Develop, cost and approve a minimum service package document

MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
40
 • Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders

• Institutionalize a system to periodically conduct orientation and

Repositioning: reorientation for SPHCB staff (including those in the LGHAs) on the
roles and responsibilities of the SPHCB, LGAs and LGHAs
89%

• Develop state strategic health development plan and incorporate

Systems MSP and investment plan
Development: • Ensure that all LGHAs have PHC AOP
71%

• Disseminate PHCUOR Implementation Guidelines to all staff at

Operational SPHCB and LGHAs
Guidelines:
67%

• Ensure that each LGHA has an independent, clearly signposted and

Office Setup: permanent office building
75%

41
RIVERS STATE
81%
RIVERS SCORECARD 6 RESULTS
120%
100% 100% 100% 100%
100% 91% 89% 86% 90%
76%
80% 67%
60%
40%
20%
0%
0%

Figure 15: Rivers State Scorecard 6 scores

Rivers State scored 81% in the PHCUOR Scorecard 6 assessment placing it in the 21st
position nationwide. Five of its nine pillars surpassed the 90% target. The least performing
pillar is MSP at 0%.

Rivers State was created in 1967. Its capital is Port-Harcourt. It has a land mass of 11,077 sq.
km (NBS 2010) with projected population of 7,303,900 by 2016 (NPC 2006). It has 23 Local
Government Areas (LGAs). There are 476 health facilities in the state: 417 (88%) are PHC
facilities and 54 (12%) are SHC facilities. Ninety-one (380) percent of the PHC facilities are
public health facilities while 9% (37) are private health facilities (NPHCDA 2015). The state’s
skilled birth attendance (SBA) is at 73%, and ANC 4+ visits at 64% (MICS 2021); while under
five mortality rate is at 79/1000 (NDHS,2018).

Table 10: Components to Improve for Rivers State

Pillars Improvement Areas

• Ensure that the Governing Board has clear roles and responsibilities
Governance & separate from that of the management team
Ownership: • Ensure that the governing board has the necessary representation
67% across all the groups including women group, ALGON, SMoLG,
SMoH
• Ensure that the Governing Board meets quarterly or biannually

42
 • Amend SPHCB Law to:
Legislation: o Make provision for the development of a costed and approved
91% Minimum Service Package (MSP) document for service delivery in
all PHC facilities in the State

• Develop, cost and approve (by the Governor) a minimum service

MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Transfer all RMNCAEH+N programmes to the SPHCB
Repositioning: • Ensure availability of TBL, Malaria, HIV/AIDs programme focal
persons in the SPHCB
89% • The SMoH should restructure the roles and responsibilities of its
departments to align with the creation of the SPHCB
• Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Funding SPHCB
Sources &
Structure:
86%

43
3.4.3.

Overview of South-West Performance

South-West had an average score of 71%. Although it did not meet the expected target of
90%. The best performing pillars in the zone are Funding Sources & Structure (94%) and
Office Setup (90%), while the least performing is MSP (40%).

SOUTH WEST SCORECARD 6 RESULTS

Ogun Ondo Osun Oyo Ekiti Lagos
100%
100%

100%

100%

100%
100%

100%
100%

100%

100%

100%

100%
100%

100%
100%
100%
100%

100%

100%
100%

100%
100%
100%
89%
89%

89%
86%
86%
86%
78%

78%

75%
75%
73%

71%
67%

67%
64%

57%
45%

44%

44%

43%
33%

33%
33%
29%

22%
0%

0%
0%
0%

0%

0%

Figure 16: Performance of the South-West zone

Only Ondo state surpassed the 90% expected target; it is the best performing state (96%),
followed by Osun state (87%). They can provide peer mentoring to the other states within the
region. Ogun is the least performing state at 26%, all its pillars require immediate attention.
The MSP pillar is a major challenge for Oyo, Ekiti and Lagos states.

44
 Oyo

Ekiti
Osun
Ondo
Ogun
States

Lagos

0 – 49
50 – 89
Legend:

90 – 100
82
82
55
87
96
26
Overall scores
(%)

Government &
Ownership

Legislation

MSP

Repositioning
Table 17: Performance of the South-West States

System
Development

Human
Resources

Funding
Sources
&Structure

Operational
Guidelines

Office Setup

45
OGUN STATE
26%

OGUN SCORECARD 6 RESULTS

100% 90%
90% 76%
80%
70% 64%
60%
50% 44% 43%
40% 33%
29%
30% 22%
20%
10% 0% 0% 0%
0%

Figure 17: Ogun State Scorecard 6 scores

Ogun State scored 26% in the PHCUOR Scorecard 6 assessment placing it in the 37th position
nationwide. None of the pillars attained the expected target of 90%. The best performing pillar
was Legislation at 64%%, all other pillars require immediate attention.

Ogun State was created in 1976. Its capital is Abeokuta. It has a land mass of 16,432 sq. km
with projected population of 5,217,700 as at 2016 (NPC 2006). It has 20 Local Government
Areas (LGAs). There are 1,520 health facilities in the State: 1375 (90%) are PHC facilities.
Thirty-five (474) percent of the PHC facilities are public health facilities while 65% (899) are
private health facilities.

The Ogun State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 74%, and ANC 4+ visits at 68% (MICS 2021); while
under five mortality rate is at 30/1000 (NDHS,2018).

46
Table 11: Components to Improve for Ogun State

Pillars Improvement Areas

• Ensure that the SPHCB has a Governing Board with clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure that the governing board has the necessary representation
33% across all the groups including women group, ALGON, SMoLG,
SMoH
• Ensure that the Governing Board meets quarterly or biannually
• Establish LG Health Authority (LGHA) with their management team
in every LGA reporting to the SPHCB
• Constitute a local government advisory committee to be headed by a
local government chairman; and LGHA management team to
manage day-to-day operations of the LGHA

Legislation: • Amend law to make provision for:

64% o Movement of PHC departments, PHC staff, programs and
funds in all LGAs in the State to the LGHAs
o The transfer of all PHC facilities in the State to the SPHCB
o The development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o The different sources of funding and expected contributions of
the State and LGAs
• Develop regulations for operationalisation of the law

• Develop, cost and approve (by the Governor) a minimum service

MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Transform all LGA PHC departments to Local Government Health
Repositioning: Areas (LGHAs) with clear reporting line to the SPHCB
• Ensure availability of TBL, Malaria, HIV/AIDs programme focal
44% persons in the SPHCB
• Conduct orientation/briefing of the key staff of the LGHA on the new
roles and responsibilities of the SPHCB and the LGHA

47
 • Develop strategic health development plan and incorporate MSP and
Systems investment plan
Development: • Develop state PHC annual operational plans (AOP) with budget
29%
incorporating all LGHA annual operational plans
• Ensure that all LGHAs have PHC AOP
• Establish a functional Integrated Supportive Supervision (ISS) plan
for the SPHCB
• Establish a functional performance review system in place for the
SPHCB's AOP across all levels (state, LGA. Facility)
• Create a distinct unit or department for Human Resources for Health
Human in the SPHCB
Resources: • Develop job description for every position in the SPHCB, LGHA and
22% facility management team
• Conduct HRH needs assessment and develop plan to fill identified
HRH gaps at the SPHCB and LGHAs
• Engage (or recruited by transfer or secondment) required staff to fill
identified HRH gaps at state and LGHAs levels
• Institutionalize a process for onboarding new staff of the SPHCB
• Ensure that there is a dedicated budget line for PHC implementation
Funding in approved LGA budgets
Source & • Ensure all LGHAs have a dedicated bank account with signatories
Structure: from among the LGHA management team
43% • Ensure all PHC staff are on the SPHCB payroll
• Institutionalize a system for regular tracking of PHC income and
expenditure
• Disseminate PHCUOR implementation guidelines
Operational • Develop operational guidelines for administrative procedures (HR,
Guidelines: 0% Admin, Logistics, Finance & Accounts, Procurement etc.)
• Conduct orientation for SPHCB staff on the vision, mission, mandate
of the SPHCB

• Ensure that the SPHCB has an independent, clearly signposted and

Office Setup: permanent office building with at least internet access, computers,
0% printers, portable water, power and power backup
• Ensure all LGHAs have independent, clearly signposted and
permanent office building with requisite office supplies

48
ONDO STATE
96%
ONDO SCORECARD 6 RESULTS
120% 100% 100% 100% 100% 100% 100% 100% 100%
100% 90%
76%
80% 67%
60%
40%
20%
0%

Figure 18: Ondo State Scorecard 6 scores

Ondo State scored 96% in the PHCUOR Scorecard 6 assessment placing it in the 7th position
nationwide. Eight out of its nine pillars scored 100%. The least performing pillar is Governance
& Ownership at 67%.

Ondo State was created in 1976. Its capital is Akure. It has a land mass of 15,500 sq. km with
projected population of 4,671,700 as at 2016 (NPC 2006). It has 18 Local Government Areas
(LGAs). There are 811 health facilities in the State: 769 (94%) are PHC facilities while 40 (5%)
are SHC facilities. Sixty (460) percent of the PHC facilities are public health facilities while
40% (309) are private health facilities (NPHCDA 2015).

The Ondo State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 66%, and ANC 4+ visits at 69% (MICS 2021); while
under five mortality rate is at 79/1000 (NDHS,2018).

Table 17: Components to Improve for Ondo State

Pillars Improvement Areas

• Ensure that the SPHCB has a Governing Board with clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure that the governing board has the necessary representation
67% across all the groups including women group, ALGON, SMoLG,
SMoH
• Ensure that the Governing Board meets quarterly or biannually

49
 OSUN STATE
87%
OSUN SCORECARD 6 RESULTS
120%
100% 100% 100% 100% 100%
100% 86% 89% 90%
73% 76%
80%
60%
40% 33%

20%
0%

Figure 22: Osun State Scorecard 6 scores

Osun State scored 87% in the PHCUOR Scorecard 6 assessment placing it in the 14th position
nationwide. Five out of its nine pillars surpassed the expected target of 90% with peak
performance at 100%. The least performing pillar is Operational Guidelines at 33%.

Osun State was created in 1991. Its capital is Osogbo. It has a land mass of 14,875 sq. km
(NBS 2010) with projected population of 4,705,600 as at 2016 (NPC 2006). It has 30 Local
Government Areas (LGAs). There are 1,095 health facilities in the State: 1,031 (94%) are PHC
facilities, 60 (6%) are SHC facilities. Sixty-six (678) percent of the PHC facilities are public
health facilities while 34% (353) are private health facilities.

The Osun State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 89%, and ANC 4+ visits at 91% (MICS 2021); while
under five mortality rate is at 70/1000 (NDHS,2018).

Table 18: Components to Improve for Osun State

Pillars Improvement Areas

Legislation: • Amend law to make provision for:

73% o Oversight role of the SMoH including reporting line from the ES
SPHCB to Commissioner for Health
o The different sources of funding and expected contributions of
the State and LGAs
• Develop regulations for operationalisation of the law

50
 • Institutionalise a system for central quarterly review for the SPHCB
Systems involving stakeholders from the SPHCB/LGHA/HF
Development:
86%

• Conduct HRH needs assessment and develop plan to fill identified

Human HRH gaps at the SPHCB and LGHAs
Resources:
89%

• Develop operational guidelines for administrative procedures (HR,

Operational Admin, Logistics, Finance & Accounts, Procurement etc.)
Guidelines: • Conduct orientation for SPHCB staff on the vision, mission, mandate
33% of the SPHCB

51
OYO STATE
55%
OYO SCORECARD 6 RESULTS
120% 100%
100% 90%
78% 71% 76%
80% 67%
57%
60% 45% 44%
33%
40%
20% 0%
0%

Figure 19: Oyo State Scorecard 6 scores

Oyo State scored 55% in the PHCUOR Scorecard 6 assessment placing it in the 29th position
nationwide. Only the Office Setup pillar surpassed the expected target of 90% at 100%. Four
out of its nine pillars require immediate attention: MSP, Legislation, Human Resources,
Operational Guidelines (0%).

Oyo State was created in 1976. Its capital is Ibadan, it has a land mass of 28,454 sq. km with
projected population of 7,840,900 as at 2016 (NPC 2006). It has 33 Local Government Areas
(LGAs) and 1,237 health facilities: 763 (62%) PHC facilities and 470 (38%) SHC facilities.
Eighty-nine (677) percent of the PHC facilities are public health facilities while 11% (86) are
private health facilities (NPHCDA 2015).

The Oyo State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 87%, and ANC 4+ visits at 76% (MICS 2021); while
under five mortality rate is at 64/1000 (NDHS,2018)

Table 19: Components to Improve for Oyo State

Pillars Improvement Areas

Governance • Ensure that the governing board has the necessary representation across
& Ownership: all the groups including women group, ALGON, SMoLG, SMoH
78% • Constitute Local Government Advisory Committee to be headed by the
Local Government Chairman for every LG Health Authority in the State

52
Legislation:
45% • Amend law to make provision for:

o Clear delineation of roles of the Governing Board from that of the

management team
o Oversight role of the SMoH including reporting line from the ES
SPHCB to Commissioner for Health
o Movement of PHC departments, PHC staff, programs and funds in all
LGAs in the State to the LGHAs and SPHCB
o The transfer of all PHC facilities in the State to the SPHCB
o The development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC facilities in
the State
• Develop regulations for operationalisation of the law
MSP: 0% • Develop, cost and approve (by the Governor) a minimum service package
document
• Ensure the MSP provide guidance for the classification/typology of PHC
facilities in the state
• Ensure the MSP document defines the minimum services, resources (HRH,
infrastructure, equipment and commodities) expected at each facility type
• Classify all PHC facilities in the State according to the MSP guidelines
• Develop a document on gap analysis of the health inputs for primary health
care delivery
• Develop an investment plan (based on the gap analysis above) to guide the
annual funding for implementing the minimum service package for PHC
facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of the
state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
Repositioning: • Transfer all PHC departments and all PHC staff in the State Ministry of
67% Local Government (SMoLG) to the SPHCB
• Ensure availability of TBL, Malaria, HIV/AIDs programme focal persons in
the SPHCB
Systems • Develop state PHC Annual Operational Plan (AOP) with budget
Development: incorporating all LGHA Annual Operational Plans
57% • Ensure that all LGHAs have PHC AOP
• Develop M&E/result/performance framework with clear milestones and
targets for the SPHCB
Human • Create a distinct unit or department for Human Resources for Health in the
Resources: SPHCB
44% • Develop job description for every position in the SPHCB, LGHA and facility
management team
• Develop a functional Human Resources Information System (HRIS) for
Human Resources for Health (HRH) Planning in the SPHCB
Funding • Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Sources & SPHCB
Structure: • Institutionalise a system to publish consolidated audited report of PHC
71% income and expenditure for the preceding year
Operational • Develop operational guidelines for administrative procedures (HR, Admin,
Guidelines: Logistics, Finance & Accounts, Procurement etc.) in the SPHCB
33% • Conduct SPHCB-wide orientation to familiarize staff at all levels with the
mandate, vision, mission of the SPHCB
53
EKITI STATE
55%
EKITI SCORECARD 6 RESULTS
120%
100% 100% 100% 100%
100% 89% 89% 86% 90%
75% 76%
80%
60%
40%
20%
0%
0%

Figure 24: Ekiti State Scorecard 6 Scores

Ekiti State scored 82% in the PHCUOR Scorecard 6 assessment placing it in the 19th position
nationwide. Four out of the nine pillars performed highly at 100%, surpassing the expected
target of 90%. The least performing pillar is MSP at 0%.

Ekiti State was created in 1996. Its capital is Ekiti. It has a land mass of 6,353 sq. km with
projected population of 3,270,800 as at 2016 (NPC 2006). It has 16 Local Government Areas
(LGAs), with 459 health facilities in the State; 395 (86%) PHC facilities and 62 (14%) SHC
facilities. Seventy-four (294) percent of the PHC facilities are public health facilities while 26%
(101) are private health facilities (NPHCDA 2015). The state has 79% SBA, 86% ANC 4+
visits, 86/1000 U5MR, 22% U5 Stunting (MICS 2016, NDHS 2018).

The Ekiti State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 84%, and ANC 4+ visits at 76% (MICS 2021); while
under five mortality rate is at 95/1000 (NDHS,2018).

54
Table 20: Components to Improve for Ekiti State

Pillars Improvement Areas

• Ensure that the governing board has the necessary representation

Governance & across all the groups including women group, ALGON, SMoLG,
Ownership: SMoH
89%

• Develop, cost and approve (by the Governor) a minimum service

MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Conduct orientation/briefing of the key staff of the LGHA on the new
Repositioning: roles and responsibilities of the SPHCB and the LGHA

89%

• Develop strategic health development plan, and incorporate MSP

Systems and investment plan
Development:
86%

• Ensure that each LGHA have an independent, clearly signposted

Office Setup: and permanent office building with requisite office equipment
75% including printers, computers, internet

55
LAGOS STATE
82%
LAGOS SCORECARD 6 RESULTS
120%
100% 100% 100% 100% 100%
100% 90%
86%
78% 75% 76%
80%

60%

40%

20%
0%
0%

Figure 25: Lagos State Scorecard 6 scores

Lagos State scored 82% in the PHCUOR Scorecard 6 assessment placing it in the 19th position
nationwide. Five out of its nine pillars had peak performance at 100%, surpassing the expected
target of 90%. The least performing pillars include MSP 0%.

Lagos State was created in 1967. Its capital is Ikeja. It has a land mass of 3, 862 sq. km with
a population of 24,600,000. It has 20 Local Government Areas (LGAs) and 2,253 health
facilities; 1,786 (80%) PHC facilities and 467 (20%) SHC facilities. Fourteen (257) percent of
the PHC facilities are public health facilities while 86% (1,529) are private health facilities. The
state’s skilled birth attendance (SBA) is at 91%, and ANC 4+ visits at 94% (MICS 2021); while
under five mortality rate is at 59/1000 (NDHS,2018).

Table 21: Components to Improve for Lagos State

Pillars Improvement Areas

• Develop, cost and approve (by the Governor) a minimum service

MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
56
 health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Transfer all RMNCAEH+N programmes to the SPHCB
Repositioning: • Conduct orientation/briefing of the key staff of the LGHA on the new
roles and responsibilities of the SPHCB and the LGHA
78%

• Develop State Strategic Health Development Plan, and incorporate

Systems MSP and investment plan
Development:
86%

• Ensure that each LGHA have an independent, clearly signposted

Office Setup: and permanent office building with requisite office equipment
75% including printers, computers, internet

57
3.4.4

Overview of North-East Performance

North-East had an average score of 82%. Although it did not meet the expected target of 90%,
it recorded 7% performance increase from the Scorecard 5 performance of 75%. The best
performing pillars in the zone were Operational Guidelines (93%), Systems Development
(91%) and Funding Sources (91%). The least performing pillar was MSP at 55%.

NORTH-EAST SCORECARD 6 RESULTS

Adamawa Bauchi Borno Gombe Taraba Yobe
100%
100%
100%
100%
100%

100%

100%

100%

100%

100%

100%
100%

100%
100%

100%

100%
100%
100%

100%
100%
100%
100%
100%

100%
100%

100%
91%
91%

89%
89%
89%
89%
86%

86%

86%
86%
78%

78%
75%

75%
71%

71%
67%

67%

67%

67%
56%

56%
45%
45%

25%
0%
0%

0%

Figure 20: Performance of the North-East zone.

Adamawa, Bauchi and Yobe States surpassed the expected target of 90%. Yobe State is the
best performing state in the zone followed by Bauchi and Adamawa states. The three states
can provide peer mentoring to the other states in the zone. Taraba (49%) is the least
performing state with huge challenges in the MSP (0%) and Office Set-up (0%) pillars.

58
 States

Yobe
Borno

0 – 49
Bauchi

Taraba

50 – 89
Gombe

Legend:
90 – 100
96
49
72
88
95
Adamawa 91
Overall
scores (%)

Governance
& Ownership

Legislation

MSP
Table 12: North-East States’ performance

Repositioning

System
Development

Human
Resources

Funding
Sources
&Structure
Operational
Guidelines

Office Setup

59
ADAMAWA STATE
91%
ADAMAWA
120%
100% 100% 100% 100%
100% 91% 89% 90%
86% 86%
76%
80%
67%
60%

40%

20%

0%

Figure 21: Adamawa State Scorecard 6 scores

Adamawa State scored 91% in the PHCUOR Scorecard 6 assessment placing it in the 11th
position nationwide. Four of its pillars recorded peak performance at 100%, and five out of the
nine pillars surpassed the expected target of 90%. The least performing pillar is MSP at 67%.

Adamawa State was created in 1991, its capital is Yola. It has a land mass of 36,917 sq. km
with projected population of 4,248,400 as at 2016 (NPC 2006). It has 21 Local Government
Areas (LGAs). There are 1,027 health facilities in the State of which 998 (97%) are PHC
facilities.

The Adamawa State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 86%, and ANC 4+ visits at 75% (MICS 2021);
while under five mortality rate is at 104/1000 (NDHS,2018).

Table 13: Components to Improve for Adamawa State

Pillars Improvement Areas

• Amend the SPHCB Law to reflect clear oversight function of the

Legislation: SMoH on the SPHCB with accountability lines
91%

60
 • Develop a document on gap analysis of the health inputs for primary
MSP: 67% health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Develop state strategic health development plan incorporating the MSP
Systems and investment plan
Development:
86%

• Conduct HRH needs assessment and develop a plan to fill identified HRH
Human gaps at the SPHCB and LGHAs
Resources:
89%

• Institutionalise a system to publish consolidated audited report of PHC

Funding income and expenditure for the preceding year
Sources &
Structure:
86%

61
 BAUCHI STATE
95%
BAUCHI
120%
100% 100% 100% 100% 100% 100%
100% 91% 89% 90%
78% 76%
80%
60%
40%
20%
0%

Figure 22: Bauchi State Scorecard 6 scores

Bauchi State scored 95% in the PHCUOR Scorecard 6 assessment placing it in the 9th position
nationwide. Seven of its pillars surpassed the expected target of 90%. Six out of the nine pillars
had peak performance at 100%. The least performing pillar is Repositioning at 78%.

Bauchi State was created in 1976. Its capital is Bauchi. It has a land mass of 49,119 sq. km
with projected population of 6,537,300 as at 2016 (NPC 2006). It has 20 Local Government
Areas (LGAs) and 1,034 health facilities in the State: 98% (1,010) PHC facilities. Ninety-five
(960) percent of the PHC facilities are public health facilities while 5% (50) are private health
facilities (NPHCDA 2015).

The Bauchi State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 43%, and ANC 4+ visits at 43% (MICS 2021); while
under five mortality rate is at 147/1000 (NDHS,2018).

62
Table 24: Components to Improve for Bauchi State

Pillars Improvement Areas

• Develop Regulations for operationalising the SPHCB Law

Legislation:
91%

• Ensure availability of TBL, Malaria, HIV/AIDs programme focal

Repositioning: persons in the SPHCB

78%

• Develop a functional Human Resources Information System (HRIS) for

Human Human Resources for Health (HRH) Planning in the SPHCB
Resources:
89%

63
BORNO STATE
88%
BORNO
120%
100% 100% 100% 100%
100% 89% 90%
86%
75% 75% 76%
80%
67%
60%

40%

20%

0%

Figure 23: Borno State Scorecard 6 scores

Borno State scored 88% in the PHCUOR Scorecard 6 assessment placing it in the 13th position
nationwide. Four out of the nine pillars recorded peak performance at 100%, surpassing the
expected target of 90%. The least performing pillars are MSP and Repositioning at 75% and
67% respectively.

Borno State was created in 1976. Its capital is Maiduguri. It has a land mass of 57,799 sq. km
(NBS 2010) with projected population of 5,860,200 as at 2016 (NPC 2006). It has 27 Local
Government Areas (LGAs) with 474 health facilities: 421 (89%) PHC facilities and 52 (11%)
SHC facilities. Ninety-seven (409) of the PHC facilities are public health facilities while 3% (12)
are private health facilities.

The Borno State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 59%, and ANC 4+ visits at 43% (MICS 2021); while
under five mortality rate is at 86/1000 (NDHS,2018).

64
Table 14: Components to Improve for Borno State

Pillars Improvement Areas

• Develop an investment plan (based on the gap analysis above) to

MSP: 75% guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Ensure availability of TBL, Malaria, HIV/AIDs programme focal
Repositioning: persons in the SPHCB

67%

• Institutionalise a process for onboarding new staff of the SPHCB

Human
Resources:
89%

• Institutionalise a functional system for regular tracking of PHC income and

Funding expenditure
Source &
Structure:
86%

• Ensure that the SPHCB office building has internet access, computers,
Office Setup: printers, portable water, power, power backup and for each of the
75% management team - office space, basic furniture, computers and printers

65
GOMBE STATE
72%
GOMBE
120%
100% 100% 100% 100%
100% 89% 90%
86%
76%
80%

60%
45%
40%
25%
20%
0%
0%

Figure 24: Gombe State Scorecard 6 scores

Gombe State scored 72% in the PHCUOR Scorecard 6 assessment placing it in the 25th
position nationwide. Four out of its nine recorded a peak performance at 100%, and surpassed
the expected target of 90%. The least performing pillars are MSP (0%), Office Set up (25%),
Legislation (45%).

Gombe State was created in 1996. Its capital is Gombe. It has a land mass of 20,265 sq. km
(NBS 2010) with projected population of 3,257,000 as at 2016 (NPC 2006). It has 11 Local
Government Areas (LGAs) with 531 health facilities; 508 (96%) are PHC facilities. Eighty-eight
(447) percent of the PHC facilities are public health facilities while 12% (61) are private health
facilities.

The Gombe State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 57%, and ANC 4+ visits at 36% (MICS 2021); while
under five mortality rate is at 189/1000 (NDHS,2018).

66
Table 15: Components to Improve for Gombe State

Pillars Improvement Areas

• Amend SPHCB Law to make provisions:

Legislation: o For the transformation of LGA PHC departments in all LGAs of
45% the State to LG Health Authorities
o Formation/reactivation of Ward Development Committees
o Oversight role of the SMoH including accountability lines
o The development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o For the recruitment, human resources management and control
in line with the PHCUOR principles
• Develop Regulations for operationalising the SPHCB Law
• Develop, cost and approve (by the Governor) a minimum service
MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Develop State Strategic Health Development Plan, and incorporate
Systems the MSP and investment plan
Development:
86%

• Ensure there is a functional Human Resources Information System

Human (HRIS) for Human Resources for Health (HRH) Planning in the
Resources: SPHCB
89%

• Ensure that the SPHCB and LGHAs have their respective independent,
Office Setup: clearly signposted and permanent office building
25% • Ensure that the office buildings have internet access, computers, printers,
portable water, power, power backup and for each of the management
team - office space, basic furniture, computers and printers

67
TARABA STATE
49%
TARABA
100% 90%
90%
78% 76%
80% 71% 71%
67%
70%
60% 56% 56%
50% 45%
40%
30%
20%
10% 0% 0%
0%

Figure 25: Taraba State Scorecard 6 scores

Taraba State scored 49% in the PHCUOR Scorecard 6 assessment placing it in the 31st
position nationwide. None of the pillars surpassed the expected target of 90%. Three of its
pillars require immediate attention: MSP (0%), Office Setup (0%), Legislation (45%).

Taraba State was created in 1991. Its capital is Jalingo. It has a land mass of 60,291 sq. km
with projected population of 3,066,800 as at 2016 (NPC 2006). It has 16 Local Government
Areas (LGAs) and 1,045 health facilities: 1,030 (99%) are PHC facilities and 14 (1.3%) are
SHC facilities. Eighty-seven (895) percent of the PHC facilities are public health facilities while
13% (135) are private health facilities.

The Taraba State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 42%, and ANC 4+ visits at 41% (MICS 2021); while
under five mortality rate is at 129/1000 (NDHS,2018).

68
Table 16: Components to Improve for Taraba State

Pillars Improvement Areas

• Establish LG Health Authority (LGHA) with management team in

Governance & every LGA with reporting line to the SPHCB
Ownership: • Establish LG Advisory Committee headed by the LGA Chairman for
78% every LG Health Authority in the State

• Amend SPHCB Law to make provisions:

Legislation: o For the transformation of LGA PHC departments in all LGAs
45% of the State to LG Health Authorities
o Formation/reactivation of Ward Development Committees
o Oversight role of the SMoH including accountability lines
o The development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o For the recruitment, human resources management and
control in line with the PHCUOR principles
• Develop Regulations for operationalising the SPHCB Law
• Develop, cost and approve (by the Governor) a minimum service
MSP: 0% package document
• Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop a document on gap analysis of the health inputs for primary
health care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Transform LGA PHC departments in all LGAs of the State to Local
Repositioning: Government Health Authorities (LGHAs) with clear reporting line to the
SPHCB
56% • Ensure availability of TBL, Malaria, HIV/AIDs programme focal
persons in the SPHCB
• Institutionalise a system to conduct orientation and reorientation of the
key staff of the LGHAs on the roles and responsibilities of the SPHCB
• Develop M&E/result/performance framework with clear milestones
Systems and targets for the SPHCB
Development: • Institutionalise a system to conduct central quarterly performance
71% review in the SPHCB involving stakeholders from the
SPHCB/LGHA/health facilities

69
 • Develop job description for every position in the SPHCB, LGHAs,
Human health facility management committee
Resources: • Update nominal roll with the names of all SPHCB and LGHAs staff
56%

• Ensure all PHC staff (SPHCB and LGHAs) are on the payroll of the
Funding SPHCB
Sources & • Institutionalise a system to regularly publish consolidated audited report
Structure: of PHC income and expenditure for the preceding year
71%

• Disseminate PHCUOR implementation guidelines to all SPHCB staff

Operational
Guidelines:
67%

• Ensure that the SPHCB and LGHAs have their respective independent,
Office Setup: clearly signposted and permanent office building
0% • Ensure that the office buildings have internet access, computers, printers,
portable water, power, power backup and for each of the management
team - office space, basic furniture, computers and printers

70
 YOBE STATE
96%
YOBE
120%
100% 100% 100% 100% 100% 100% 100% 100%
100% 90%
76%
80% 67%
60%
40%
20%
0%

Figure 26: Yobe State Scorecard 6 scores

Yobe State scored 96% in the PHCUOR Scorecard 6 assessment placing it in the 7th position
nationwide. All the pillars recorded peak performance at 100%, surpassing the expected target
of 90%, excluding Governance & Ownership (67%).

Yobe State was created in 1991 out of Borno State. Its capital is Damaturu. It has a land mass
of 45,502 sq. km with projected population of 3,294,100 as at 2016 (NPC 2006). It has 17
Local Government Areas (LGAs) and 517 health facilities: 486 (94%) PHC facilities, 30 (6%)
SHC facilities and 1 tertiary hospital. All PHC facilities are public health facilities (NPHCDA
2015).

The Yobe State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 58%, and ANC 4+ visits at 53% (MICS 2021); while
under five mortality rate is at 152/1000 (NDHS,2018).

Table 17: Components to Improve for Yobe State

Pillars Improvement Areas

• Ensure that the SPHCB has a Governing Board with clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure that the governing board has the necessary representation
67% across all the groups including women group, ALGON, SMoLG,
SMoH
• Ensure that the Governing Board meets quarterly or biannually

71
3.4.5.

Overview of North Central Performance

The North Central had an average score of 71%. Although it did not meet the expected target
of 90%, it recorded 8% performance increase from the Scorecard 5 performance of 63%. The
best performing pillars in the zone are Office Setup, Funding Sources and Operational
Guidelines. The least performing pillars are MSP at 57%.

NORTH CENTRAL
Benue Kogi Kwara Nasarawa Niger Plateau FCT, Abuja

100%
100%
100%

100%
100%

100%

100%
100%

100%
100%

100%
100%
100%

100%

100%
100%

100%
100%
100%
100%

100%
100%
100%
92%
92%
91%
91%
89%

89%

86%

86%
86%
82%

78%
78%

78%

75%
71%

71%
71%
67%
67%

67%
56%

56%
56%

50%
45%
33%

33%

33%

33%

33%
33%
29%
29%
27%

14%

0%
0%
0%
0%

0%

Figure 27: Performance of the North Central zone.

Only Niger and Plateau states surpassed the expected target of 90%. Both states can peer
mentor the other states in the region. Kogi and Kwara were the least performing states and
upto 90% of the pillars require immediate attention. They are of major concerns in the zone
and require expedited support to establish their pillars.

72
 States

FCT
Kogi

Niger

0 – 49
Kwara
Benue

50 – 89
Plateau

Legend:
90 – 100
83
99
99
Nasarawa 80
39
42
54
Overall scores
(%)

Governance &
Ownership

Legislation

MSP
Table 29: North Central States’ Performance

Repositioning

System
Development

Human
Resources

Funding
Sources
&Structure
Operational
Guidelines

Office Setup

73
BENUE STATE
54%
BENUE
120%
100%
100% 90%
78% 78% 76%
80%
56%
60% 50%

40% 33% 29% 33%

27%
20%

0%

Figure 28: Benue State Scorecard 6 scores

Benue State scored 54% in the PHCUOR Scorecard 6 assessment placing it in the 30th
position nationwide. Only one out of the nine pillars recorded peak performance at 100%,
surpassing the expected target of 90%. Most of its pillars recorded poor performance.

Benue State was created in 1976, its capital is Makurdi. It has a land mass of 33,955 sq. km
with projected population of 5,741,800 as at 2016 (NPC 2006). It has 23 Local Government
Areas (LGAs). The existing 1,206 health facilities in the State comprise 1,111 (92%) PHC
facilities and 30 (6%) SHC facilities. Sixty-nine (771) percent of the PHC facilities are public
health facilities while 31% (340) are private health facilities.

The Benue State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 69%, and ANC 4+ visits at 47% (MICS 2021); while
under five mortality rate is at 59/1000 (NDHS,2018).

74
Table 18: Components to Improve for Benue State

Pillars Improvement Areas

• Constitute Local Government Advisory Committee headed by the Local

Governance & Government Chairman in all the LGAs
Ownership: • Constitute Facility Management Committee (FMC) in each of the ward
78% focal Primary Health Centres in the state

• Amend SPHCB Law to make provisions for the:

Legislation: o Transformation of LGA PHC departments in all LGAs of the
27% State to LG Health Authorities
o Formation/reactivation of Ward Development Committees
o Oversight role of the SMoH including accountability lines
o Movement of PHC departments, PHC staff, programs and
funds in all LGAs in the State to the LGHAs
o Development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o Recruitment, human resources management and control in
line with the PHCUOR principles
• Develop Regulations for operationalising the SPHCB Law
• Classify all PHC facilities in the state according to MSP guidelines
MSP: 33% • Ensure that the MSP document defines the minimum resources
(HRH, infrastructure, equipment, medicines and consumables)
expected at each facility type
• Cost the developed MSP
• Develop gap analysis report on the health inputs for primary health
care delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate MSP document to all key stakeholders, LGHAs and
PHC facilities in the State
• Transfer all RMNCAEH+N programmes to the SPHCB
Repositioning: • Institutionalise a system to conduct orientation and reorientation of
the key staff of the LGHAs on the roles and responsibilities of the
78% SPHCB; conduct orientation every six months

• Ensure that all LGHAs have PHC AOP

Systems • Develop state PHC Annual Operational Plan (AOP) with budget
Development: incorporating all LGHA Annual Operational Plans
29% • Develop M&E/result/performance framework with clear milestones
and targets for the SPHCB
• Develop and implement Integrated Supportive Supervision (ISS) plan
for the SPHCB
75
 • Institutionalise a central quarterly performance review for the SPHCB
involving stakeholders from the SPHCB/LGHA/HF
• Create a distinct unit or department for Human Resources for Health in
Human the SPHCB
Resources: • Develop job description for every position in the SPHCB, LGHAs, health
56% facility management committee
• Develop a functional Human Resources Information System (HRIS) for
Human Resources for Health (HRH) Planning in the SPHCB
• Disseminate PHCUOR implementation guidelines to all staff at SPHCB
Operational and LGHA levels
Guidelines: • Conduct orientation for SPHCB staff including management team of
33% SPHCB and LGHAs on the mandate, mission and vision of the SPHCB
using the operational guidelines
• Ensure that SPHCB and LGHA office buildings have internet access,
Office Setup: computers, printers, portable water, power, power backup and for each of
50% the management team - office space, basic furniture, computers and
printers
• Ensure that each LGHA has an independent, clearly signposted and
permanent office building

76
FCT
83%
FCT
120%
100% 100% 100%
100% 86% 90%
82% 78%
71% 76%
80% 67% 67%
60%

40%

20%

0%

Figure 29: FCT Scorecard 6 scores

FCT scored 83% in the PHCUOR Scorecard 6 assessment placing it in the 18th position
nationwide. Four out of the nine pillars had a peak performance at 100%, surpassing the
expected target of 90%. The least performing pillars are Repositioning 45% and Governance
& Ownership 50%.

FCT was created in 1976 from parts of Niger, Nasarawa and Kogi States. Its capital is Abuja.
It has a land mass of 7,315 sq. km with projected population of 3,564,100 as at 2016 (NPC
2006). It has six Area Councils (ACs) with 656 health facilities: 559 (85%) PHC facilities and
90 (14%) SHC facilities. Thirty-two (179) percent of the PHC facilities are public health facilities
while 68% (380) are private health facilities.

The FCT Primary Health Care Board is implementing the Basic Health Care Provision Fund
(BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility financing
(DFF) to run operational expenses. The facilities are also enrolled under the National Health
Insurance Scheme to provide free health services to vulnerable populations. The state’s skilled
birth attendance (SBA) is at 72%, and ANC 4+ visits at 76% (MICS 2021); while under five
mortality rate is at 106/1000 (NDHS,2018).

Table 19: Components to Improve for FCT

Pillars Improvement Areas

• Ensure that the Governing Board of the SPHCB has clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure Governing Board has the necessary representation from
67% Women group, ALGON, SMoH, SMoLG
• Ensure that Governing Board meets quarterly or biannually
77
 • Amend the SPHCB Law to make provision for
Legislation: o The movement of PHC departments, PHC staff, PHC
82% programmes and PHC funds in all LGAs in the State to the
LGHAs and SPHCB
o The transfer of all PHC facilities in the State to the SPHCB
• Transfer PHC department and staff in the State Ministry of Health
Repositioning: (SMoH) to the SPHCB
• Transfer PHC department and staff in the State Ministry of Local
67% Government and Chieftaincy Affairs (SMoLG&CA) to the SPHCB
• Institutionalise a system to conduct orientation and reorientation for
SPHCB/LGHA staff on the roles and responsibilities of the SPHCB,
conduct orientation every six months
• Develop State Strategic Health Development Plan incorporating the MSP
Systems and investment plan
Development: • Institutionalise a system for central quarterly performance review for the
71% SPHCB's AOP across all levels involving stakeholders from SPHCB,
LGHAs, health facilities
• Develop a functional Human Resources Information System (HRIS) for
Human Human Resources for Health (HRH) Planning in the SPHCB
Resources: • Institutionalise a process for onboarding new staff of the SPHCB
78%

• Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Funding SPHCB
Sources &
Structure:
86%

78
KOGI STATE
42%
KOGI
100% 89% 91% 90%
90% 76%
80% 71%
70%
56% 56%
60%
50%
40%
30%
20% 14%
10% 0% 0% 0%
0%

Figure 30: Kogi Scorecard 6 scores

Kogi State scored 42% in the PHCUOR Scorecard 6 assessment placing it in the 34th position
nationwide. Its best performing pillar is Legislation at 91%.

Kogi State was created in 1991 from parts of Kwara and Benue States. Its capital is Lokoja. It
has a land mass of 29,833 sq. km with projected population of 4,473,500 as at 2016 (NPC
2006). It has 21 Local Government Areas (LGAs). There are 1,077 health facilities in the State:
868 (81%) are PHC facilities and 28 (3%) are SHC facilities. Ninety-five (823) percent of the
PHC facilities are public health facilities while 5% (45) are private health facilities.

The Kogi State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 79%, and ANC 4+ visits at 73% (MICS 2021); while
under five mortality rate is at 148/1000 (NDHS,2018).

Table 20: Components to Improve for Kogi State

Pillars Improvement Areas

Governance & • Establish LG Advisory Committee headed by the LGA Chairman

Ownership: for every LG Health Authority in the State
89%

79
 • Amend law to make provision for the development of a costed and
Legislation: approved Minimum Service Package (MSP) document for service
91% delivery in all PHC facilities in the State

• Develop, cost and approve a minimum service package document

MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop gap analysis report on health inputs for primary health care
delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders

• Transfer all PHC staff and programs including malaria, HIV/AIDS,

Repositioning: TBL, FP/MCH/Nutrition and Immunization programs in the SMoH and
SMoLGA to the SPHCB
56% • Ensure that there are Malaria, HIV/AIDS, TBL focal persons in the
SPHCB
• Institutionalise a system to conduct orientation and reorientation of
the key staff of the LGHAs on the roles and responsibilities of the
SPHCB; conduct orientation every six months
• Develop State Strategic Health Development Plan incorporating
Systems the MSP and investment plan
Development: • Develop State PHC Annual Operational Plan (AOP) with budget
14% incorporating all LGHA Annual Operational Plans
• Ensure that all LGHAs have PHC AOP
• Develop M&E/result/performance framework with clear milestones
and targets for the SPHCB
• Establish a functional Integrated Supportive Supervision (ISS) plan
for the SPHCB
• Establish a functional quarterly performance review system for the
SPHCB involving stakeholders from the SPHCB, LGA. Facility
• Establish a functional data quality assurance system in place

Human • Develop job description for every position in the SPHCB, LGHA and
Resources: health facility management committee
56% • Ensure availability of a functional Human Resources Information
System (HRIS) for Human Resources for Health (HRH) Planning in
the SPHCB

80
 • Create a dedicated budget line for PHC implementation in approved
Funding annual LGA budgets
Source & • Ensure all PHC staff on the SPHCB payroll
Structure:
71%

• Disseminate PHCUOR implementation guidelines to all staff at the

Operational SPHCB and LGHA
guidelines: • Develop Operational Guidelines for administrative procedures (HR,
0% Admin, Logistics, Finance & Accounts, Procurement etc) in the
SPHCB
• Conduct orientation for SPHCB staff on the vision, mission, mandate
of the SPHCB

• Ensure SPHCB and LGHAs have independent, clearly signposted and

Office Setup: permanent office building
0% • Ensure that SPHCB and LGHA office buildings have at least internet
access, computers, printers, portable water, power, power backup and
for each of the management team - office space, basic furniture,
computers and printers

81
KWARA STATE
39%
KWARA
100% 90%
90% 75% 76%
80% 71%
70%
60% 45%
50%
40% 33% 33% 29% 33% 33%
30%
20%
10% 0%
0%

Figure 31: Kwara Scorecard 6 scores

Kwara State scored 39% in the PHCUOR Scorecard 6 assessment placing it in the 35 th
position nationwide. Its best performing pillars are Funding Sources & Structure and Office Set
up at 71% and 75% respectively. All other pillars require immediate attention.

Kwara State was created in 1967. Its capital is Ilorin. It has a land mass of 32,500 sq. km with
projected population of 3,192,900 as at 2016 (NPC 2006). It has 16 Local Government Areas
(LGAs). The 740 health facilities in the State comprise 575 (78%) PHC facilities and 164 (22%)
SHC facilities. Eighty-nine (512) of the PHC facilities are public health facilities while 11% (63)
are private health facilities.

The Kwara State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 85%, and ANC 4+ visits at 77% (MICS 2021); while
under five mortality rate is at 74/1000 (NDHS,2018).

82
Table 21: Components to Improve for Kwara State

Pillars Improvement Areas

• Ensure that the Governing Board of the SPHCB has clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure Governing Board has the necessary representation from
33% Women group, ALGON, SMoH, SMoLG
• Ensure that Governing Board meets quarterly or biannually
• Establish LG Health Authority (LGHA) with management team in
every LGA with reporting line to the SPHCB
• Establish LG Advisory Committee headed by the LGA Chairman for
every LG Health Authority in the State
• Amend SPHCB Law to make provisions for the:
Legislation: o Oversight role of the SMoH including accountability lines
45% o Movement of PHC departments, PHC staff, programs and
funds in all LGAs in the State to the SPHCB and LGHAs
o Development of a costed and approved Minimum Service
Package (MSP) document for service delivery in all PHC
facilities in the State
o Recruitment, human resources management and control in
line with the PHCUOR principles
o Different sources of funding and expected contributions of
the State and LGAs
• Develop Regulations for operationalizing the SPHCB Law
• Develop, cost and approve a minimum service package document
MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop gap analysis report on health inputs for primary health care
delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders

• Transform all LGA PHC departments to Local Government Health

Repositioning: Areas (LGHAs) with clear reporting line to the SPHCB
• Transfer all RMNCAEH+N programmes to the SPHCB
33% • Ensure that there are Malaria, HIV/AIDS, TBL focal persons in the
SPHCB
• Institutionalise a system to conduct orientation and reorientation of
the key staff of the LGHAs on the roles and responsibilities of the
SPHCB; conduct orientation every six months

83
 • Develop State Strategic Health Development Plan, and incorporate
Systems the MSP and investment plan
Development: • Develop State PHC Annual Operational Plan (AOP) with budget
29% incorporating all LGHA Annual Operational Plans
• Ensure that all LGHAs have PHC AOP
• Establish a functional quarterly performance review system for the
SPHCB's AOP involving stakeholders across all levels (SPHCB,
LGHA. Facility)
• Establish a functional data quality assurance system

Human • Develop job description for every position in the SPHCB, LGHA and
Resources: health facility management committee
33% • Update SPHCB nominal roll to incorporate names of all SPHCB and
LGHA staff
• Ensure availability of a functional Human Resources Information
System (HRIS) for Human Resources for Health (HRH) Planning in
the SPHCB
• Conduct HRH needs assessment and develop plan to fill identified
HRH gaps at the SPHCB and LGHAs
• Engage (or recruit by transfer or secondment) required staff to fill
identified HRH gaps at State and LGHAs levels
• Institutionalise a process in place for onboarding new staff of the
SPHCB

Funding • Ensure all LGHAs have a dedicated bank account with signatories
Sources & from among the LGHA management team
Structure: • Ensure all PHC staff are on the SPHCB payroll
71%

• Develop Operational Guidelines for administrative procedures (HR,

Operational Admin, Logistics, Finance & Accounts, Procurement etc.) in the
guidelines: SPHCB
33% • Conduct orientation for SPHCB staff on the vision, mission,
mandate of the SPHCB

• Ensure that each LGHA have an independent, clearly signposted and

Office Setup: permanent office building with requisite office supplies
75%

84
NASARAWA STATE
80%
NASARAWA
120%
100% 100% 100%
100% 91% 89% 86% 86% 90%
76%
80% 67%
60%
40%
20%
0%
0%

Figure 32: Nasarawa Scorecard 6 scores

Nasarawa State scored 80% in the PHCUOR Scorecard 6 assessment placing it in the 22nd
position nationwide. Three of its pillars surpassed the expected target of 90%, and two
recorded a peak performance of 100%. The least performing pillar is MSP at 0%.

Nasarawa State was created in 1996. Its capital is Lafia. It has a land mass of 28,735 sq. km
with projected population of 2,523,400 as at 2016 (NPC 2006). It has 13 Local Government
Areas (LGAs) with 1,070 health facilities: 998 (93%) PHC facilities, 17 (2%) SHC facilities, and
2 (0.1%) tertiary health facilities. Seventy-six (756) percent of the PHC facilities are public
health facilities while 24% (242) are private health facilities

The Nasarawa State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 72%, and ANC 4+ visits at 45% (MICS 2021);
while under five mortality rate is at 120/1000 (NDHS,2018).

85
Table 22: Components to Improve for Nasarawa State

Pillars Improvement Areas

• Ensure that the Governing Board of the SPHCB has clear roles and
Governance & responsibilities separate from that of the management team
Ownership: • Ensure Governing Board has the necessary representation from
67% Women group, ALGON, SMoH, SMoLG
• Ensure that Governing Board meets quarterly or biannually
• Develop Regulation for operationalising the SPHCB Law
Legislation:
91%

• Develop, cost and approve a minimum service package document

MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop gap analysis report on health inputs for primary health care
delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Ensure that there is a TBL focal person in the SPHCB
Repositioning:

89%

• Develop State Strategic Health Development Plan, and incorporate

Systems the MSP and investment plan
Development:
86%

• Ensure that all PHC staff (SPHCB and LGHAs) are on the payroll of
Funding the SPHCB
Source &
Structure:
86%

86
NIGER STATE
99%
NIGER
120%
100% 100% 100% 100% 100% 100% 100% 100%
100% 92% 90%
76%
80%
60%
40%
20%
0%

Figure 33: Niger Scorecard 6 scores

Niger State scored 99% in the PHCUOR Scorecard 6 assessment placing it in the 2nd position
nationwide. All the pillars had a peak performance at 100%, surpassing the expected target of
90%, except the MSP pillar (92%).

Niger State was created in 1976. Its capital is Minna. It has a land mass of 76,363 sq. km with
projected population of 5,556,900 as at 2016 (NPC 2006). There are 25 Local Government
Areas (LGAs) with 1,335 health facilities of which 1,322 (99%) are PHC facilities. Eighty-three
(1,095) percent of the PHC facilities are public health facilities while 17% (227) are private
health facilities.

The Niger State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 63%, and ANC 4+ visits at 55% (MICS 2021); while
under five mortality rate is at 98/1000 (NDHS,2018).

Table 23: Component to Improve for Niger State

Pillars Improvement Areas

• Disseminate the approved MSP document to all stakeholders

MSP: 92%

87
PLATEAU STATE
99%
PLATEAU
120%
100% 100% 100% 100% 100% 100% 100% 100%
100% 92% 90%
76%
80%
60%
40%
20%
0%

Figure 34: Plateau Scorecard 6 scores

Plateau State scored 99% in the PHCUOR Scorecard 6 assessment placing it in the 2nd
position nationwide. All the pillars had a peak performance at 100%, surpassing the expected
target of 90%, except the MSP pillar (92%).

Plateau State was created in 1976. Its capital is Jos. It has a land mass of 26,899 sq. km with
projected population of 4,200,400 as at 2016 (NPC 2006). Plateau State has 17 Local
Government Areas (LGAs) and 883 health facilities: 833 (94%) PHC facilities, 49 (6%) SHC
and 1 tertiary facility. Eighty-seven (729) percent of the PHC facilities are public health facilities
while 12% (104) are private health facilities (NPHCDA 2015).

The Plateau State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 82%, and ANC 4+ visits at 70% (MICS 2021); while
under five mortality rate is at 106/1000 (NDHS,2018).

Table 36: Component to Improve for Plateau State

Pillars Established Criteria

• Develop gap analysis report on health inputs for primary health care
MSP: 73% delivery

88
3.4.6

Overview of North-West Performance

The North-West had an average score of 86% - the highest score across the zones. Although
it did not meet the expected target of 90%, it recorded 3% performance increase from the
Scorecard 5 performance (83%). The best performing pillar in the zone is Systems
Development (100%) followed by Funding Sources (94%), Human Resources (93%),
Repositioning (93%).

NORTH WEST
Jigawa Kaduna Kano Katsina Kebbi Sokoto Zamfara
100%
100%
100%
100%
100%
100%

100%
100%
100%
100%
100%

100%
100%
100%
100%

100%
100%
100%
100%

100%
100%
100%
100%
100%
100%

100%
100%

100%
100%
100%
100%

100%
100%
100%
100%

100%
100%
100%
100%
89%

89%

89%
89%
89%
89%

86%

86%
86%
83%
82%

75%
75%
67%

67%

67%
64%

57%
33%

33%
0%
0%

0%

0%

Figure 35: Performance of the North-West zone.

Kaduna, Kebbi and Zamfara States surpassed the expected target of 90% and are the best
performing states in the zone at 98%. They can provide peer mentoring to other states in the
zone. Jigawa state is the least performing and scored 0% in the MSP and Office Setup pillars.
Katsina and Kano states scored 0% in the MSP and Operational Guidelines pillar respectively.

89
 States

Kano

Kebbi

0 – 49
Jigawa

Sokoto

50 – 89
Katsina
Kaduna

Legend:
90 – 100
Zamfara 98
87
98
84
85
98
49
Overall scores
(%)

Governance &
Ownership

Legislation

MSP
Table 24: North-West States’ Performance

Repositioning

Systems
Development

Human
Resources

Funding
Sources
&Structure
Operational
Guidelines

Office Setup

90
 JIGAWA STATE
49%
JIGAWA
120%
100%
100% 86% 90%
76%
80% 64% 67%
57%
60%
40% 33% 33%

20%
0% 0%
0%

Figure 36: Jigawa State Scorecard 6 scores

Jigawa State scored 49% in the PHCUOR Scorecard 6 assessment placing it in the 31st
position nationwide. Only one out of the nine pillars had a peak performance of 100%;
surpassing the expected target of 90%. The least performing pillars are MSP, Office Setup,
Repositioning, Operational Guidelines.

Jigawa State was created in 1991 from Kano State. Its capital is Dutse. It has a land mass of
22,410 sq. km with projected population of 5,828,200 as at 2016 (NPC 2006). There are 27
Local Government Areas (LGAs) in the State and 614 health facilities: 598 (97%) PHC facilities
and 14 (2.3%) SHC facilities. Ninety-six (595) percent of the PHC facilities are public health
facilities while 1% (3) are private PHC facilities (NPHCDA 2015). The SPHCB was established
in 2016, and the law establishing the Board was also passed in 2016.

The Jigawa State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 72%, and ANC 4+ visits at 46% (MICS 2021); while
under five mortality rate is at 213/1000 (NDHS,2018).

91
Table 25: Components to Improve for Jigawa State

Pillars Improvement Areas

• Amend the SPHCB law to incorporate:

Legislation: o Transformation of LGA PHC departments in all LGAs to LGHAs with
64% reporting line to the SPHCB
o Transfer of all PHC facilities in the state to the SPHCB
o Recruitment, human resources management and control in line with
the PHCUOR principles
• Develop Regulations for operationalizing the SPHCB Law
• Develop, cost and approve a minimum service package document
MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
• Classify all PHC facilities in the State according to the MSP
guidelines
• Develop gap analysis report on health inputs for primary health care
delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Transfer PHC department and staff in the SMoH, SMoLGA to the
Repositioning: SPHCB
• Transform LGA PHC departments in all LGAs to LGHAs with clear
33% reporting lines to the SPHCB
• Ensure availability of Malaria, HIV/AIDS and TBL focal persons in the
SPHCB
• Develop State Strategic Health Development Plan incorporates the
Systems MSP and investment plan
Development: • Ensure that each LGHA has a PHC Annual Operational Plan
57% • Institutionalize a system to conduct central quarterly performance
review of the SPHCB's AOP involving stakeholders across all levels
(state, LGA. Facility)
• Ensure availability of an up-to-date nominal roll with the names of all
Human SPHCB and LGHAs staff
Resources: • Engage (or recruit by transfer or secondment) required staff to fill
67% identified HRH gaps at State and LGHAs levels
• Institutionalise a process in place for onboarding new staff of the
SPHCB
• Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Funding SPHCB
Sources &

92
Structure:
86%

• Develop operational guidelines for administrative procedures (HR,

Operational Admin, Logistics, Finance & Accounts, Procurement etc.) in the
Guidelines: SPHCB
33% • Conduct orientation for SPHCB personnel (management team of
SPHCB and LGHAs) on the mandate, mission and vision of the
SPHCB using the operational guidelines
• Ensure that the SPHCB and LGHAs have independent, clearly
Office Setup: signposted and permanent office building
0% • The SPHCB and LGHA office building should be equipped with
internet access, computers, printers, portable water, power, power
backup and for each of the management team - office space, basic
furniture, computers and printers

93
KADUNA STATE
98%
KADUNA
120%
100% 100% 100% 100% 100% 100% 100%
100% 89% 89% 90%
76%
80%
60%
40%
20%
0%

Figure 37: Kaduna State Scorecard 6 scores

Kaduna State scored 98% in the PHCUOR Scorecard 6 assessment placing it in the 4th
position nationwide. Seven out of the nine pillars recorded peak performance of 100%;
surpassing the expected target of 90%. Repositioning 89% and Human Resources 89% were
the least performing pillars.

Kaduna State was created in 1967. Its capital is Kaduna. It has a land mass of 46,053 sq. km
(NBS 2010) with projected population of 8,252,400 as at 2016 (NPC 2006). It has 23 Local
Government Areas (LGAs) and 1,560 health facilities: 1,523 (98%) are PHC facilities and 33
(2%) are SHC facilities. The PHC facilities are made up of 1,007 (66%) public health facilities
and 516 (34%) private PHC facilities (NPHCDA 2015). The SPHCB was established in 2010
and the law establishing it was passed in 2015.

The Kaduna State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 85%, and ANC 4+ visits at 72% (MICS 2021);
while under five mortality rate is at 187/1000 (NDHS,2018).

Table 39: Components to Improve for Kaduna State

Pillars Established Criteria

Repositioning: • Transfer all RMNCAEH+N programmes to the SPHCB

89%
Human • Institutionalize a process for onboarding new SPHCB staff
Resources:
89%
94
KANO STATE
85%
KANO
120%
100% 100% 100% 100% 100% 100%
100% 89% 90%
75% 76%
80%
60%
40%
20%
0%
0%

Figure 38: Kano State Scorecard 6 scores

Kano State scored 85% in the PHCUOR Scorecard 6 assessment placing it in the 16th position
nationwide. Six out of its nine pillars had peak performance at 100%; surpassing the expected
target of 90%. The least performing pillars was Operational Guidelines (0%).

Kano State was created in 1967. Its capital is Kano. It has a land mass of 20,131sq. km with
projected population of 13,076,900 as at 2016 (NPC 2006). It has 44 Local Government Areas
(LGAs). There are 1,183 health facilities in the State with 1,142 (96%) PHC facilities and 39
(3.3%) SHC facilities. The PHC facilities are made up of 1,037 (91%) public health facilities
and 105 (9%) private PHC facilities (NPHCDA 2015). The SPHCB was established in 2012
and the law establishing it passed in 2012.

The Kano State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 73%, and ANC 4+ visits at 49% (MICS 2021); while
under five mortality rate is at 164/1000 (NDHS,2018).

Table 26: Components to Improve for Kano State

Pillars Established Criteria

• Recruit or engage (or recruited by transfer or secondment) required

Human staff to fill identified HRH gaps at State and LGHAs levels
Resources:
89%

95
 • Disseminate the PHCUOR implementation guidelines to all SPHCB
Operational staff at state and LGA levels
Guidelines: • Develop operational guidelines for administrative procedures (HR,
0% Admin, Logistics, Finance & Accounts, Procurement etc.) in the
SPHCB
• Conduct orientation for SPHCB personnel (management team of
SPHCB and LGHAs) on the mandate, mission and vision of the
SPHCB using the operational guidelines
• Ensure that each LGHA have an independent, clearly signposted and
Office Setup: permanent office building
75% • Ensure that the office building has internet access, computers,
printers, portable water, power, power backup and for each of the
management team - office space, basic furniture, computers and
printers

96
KATSINA STATE
84%
KATSINA
120%
100% 100% 100% 100% 100% 100%
100% 89% 90%
76%
80% 67%
60%
40%
20%
0%
0%

Figure 39: Katsina State Scorecard 6 scores

Katsina State scored 84% in the PHCUOR Scorecard 6 assessment placing it in the 17th
position nationwide. Six out of its nine pillars had peak performance at 100%: surpassing the
expected target of 90%. The least performing pillars was MSP (0%).

Katsina State was created in 1987 from Kaduna State. Its capital is Katsina. It has a land
mass of 24,971 sq. km, with projected population of 7,831,300 as at 2016 (NPC 2006) and 34
Local Government Areas (LGAs). There are 1,496 health facilities in the State with 1,463
(98%) PHC facilities and 32 (2%) SHC facilities. The PHC facilities are made up of 1,418
(86%) public health facilities and 45 (3.1) private PHC facilities (NPHCDA 2015).

The Katsina State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 40%, and ANC 4+ visits at 42% (MICS 2021); while
under five mortality rate is at 188/1000 (NDHS,2018).

Table 27: Components to Improve for Katsina State

Pillars Improvement Areas

• Develop, cost and approve a minimum service package document

MSP: 0% • Ensure the MSP provide guidance for the classification/typology of
PHC facilities in the state
• Ensure the MSP document defines the minimum services, resources
(HRH, infrastructure, equipment and commodities) expected at each
facility type
97
 • Classify all PHC facilities in the State according to the MSP
guidelines
• Develop gap analysis report on health inputs for primary health care
delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the state
• Ensure that MSP costing and investment plan takes cognizance of
the state's fiscal space
• Make provision for the investment plan in annual state budget
• Disseminate the MSP document to all stakeholders
• Ensure availability of Malaria, HIV/AIDS and TBL focal persons in the
Repositioning: SPHCB

67%

• Create a distinct unit/department for Human Resources for Health in

Human the SPHCB
Resources:
89%

98
KEBBI STATE
98%
KEBBI
120%
100% 100% 100% 100% 100% 100% 100% 100%
100% 86% 90%
76%
80%
60%
40%
20%
0%

Figure 40: Kebbi State Scorecard 6 scores

Kebbi State scored 98% in the PHCUOR Scorecard 6 assessment placing it in the 4th position
nationwide. All but one of the pillars surpassed the expected target of 90%. Eight out of the
nine pillars recorded peak performance at 100%.

Kebbi State was created in 1991 from Sokoto State. Its capital is Birnin Kebbi. It has a land
mass of 37,699 sq. km with projected population of 4,440,000 as at 2016 (NPC 2006). It has
21 Local Government Areas (LGAs) and 412 health facilities; 380 (92%) PHC facilities and
31(8%) SHC facilities. The PHC facilities are made up of 375 (97%) public health facilities and
5 (1%) private PHC facilities (NPHCDA 2015). The SPHCB was established in 2011; the law
establishing the SPHCB was passed in 2016.

The Kebbi State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 42%, and ANC 4+ visits at 37% (MICS 2021); while
under five mortality rate is at 255/1000 (NDHS,2018).

Table 28: Components to Improve for Kebbi State

Pillars Improvement Areas

• Ensure that all PHC staff (State and LGHAs) are on the payroll of
Funding Sources the SPHCB
& Structure: 86%

99
SOKOTO STATE
87%

SOKOTO
120%
100% 100% 100%
100% 89% 89% 86% 90%
82%
75% 76%
80% 67%
60%
40%
20%
0%

Figure 41: Sokoto State Scorecard 6 scores

Sokoto State scored 87% in the PHCUOR Scorecard 6 assessment placing it in the 14th
position nationwide. Three out of the nine pillars had peak performance at 100%: surpassing
the expected target of 90%.

Sokoto State was created in 1976. Its capital is Sokoto. It has a land mass of 25,973 sq. km
with projected population of 4,998,100 as at 2016 (NPC 2006). There are 23 Local
Government Areas (LGAs) and 713 health facilities; 668 (94%) PHC facilities and 43 (6%)
SHC facilities. All PHC facilities are public.

The Sokoto State Primary Health Care Board is implementing the Basic Health Care Provision
Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct facility
financing (DFF) to run operational expenses. The facilities are also enrolled under the National
Health Insurance Scheme to provide free health services to vulnerable populations. The
state’s skilled birth attendance (SBA) is at 31%, and ANC 4+ visits at 27% (MICS 2021); while
under five mortality rate is at 197/1000 (NDHS,2018).

100
Table 29: Components to Improve for Sokoto State

Pillars Improvement Areas

• Ensure that the Governing Board meets quarterly/biannually

Governance &
Ownership:
89%

• Amend the SPHCB Law and incorporate

Legislation: o Oversight role of the SMoH including accountability lines
82% o Recruitment, human resources management and control in line with
the PHCUOR principles
• There is Regulation for operationalising the SPHCB Law
• Develop job description for the health facility management team
Human
Resources:
89%

• Ensure that all PHC staff (State and LGHAs) are on the payroll of the
Funding SPHCB
Sources &
Structure:
86%

• Conduct orientation for SPHCB personnel (management team of

Operational SPHCB and LGHAs) on the mandate, mission and vision of the
Guidelines: SPHCB using the operational guidelines
67%

• Ensure that each LGHA have an independent, clearly signposted and

Office Setup: permanent office building
75% • Ensure that the office building has internet access, computers,
printers, portable water, power, power backup and for each of the
management team - office space, basic furniture, computers and
printers

101
ZAMFARA STATE
98%
ZAMFARA
120%
100% 100% 100% 100% 100% 100% 100% 100%
100% 90%
83%
76%
80%
60%
40%
20%
0%

Figure 42: Zamfara State Scorecard 6 scores

Zamfara State scored 98% in the PHCUOR Scorecard 6 assessment placing it in the 4 th
position nationwide. All its pillars excluding MSP recorded peak performance at 100%.

Zamfara State was created in 1996. Its capital is Gusau. It has a land mass of 38,418 sq. km
with projected population of 4,515,400 as at 2016 (NPC 2006). It has 14 Local Government
Areas (LGAs). The 697 health facilities in the State comprise 677 (97%) PHC facilities and 19
(3%) SHC facilities. Of the PHC facilities, 664 (98%) are public health facilities while 13 (2%)
are private health facilities.

The Zamfara State Primary Health Care Board is implementing the Basic Health Care
Provision Fund (BHCPF). The BHCPF eligible health facilities receive monthly funds as direct
facility financing (DFF) to run operational expenses. The facilities are also enrolled under the
National Health Insurance Scheme to provide free health services to vulnerable populations.
The state’s skilled birth attendance (SBA) is at 34%, and ANC 4+ visits at 17% (MICS 2021);
while under five mortality rate is at 130/1000 (NDHS,2018).

Table 30: Components to Improve for Zamfara State

Pillars Improvement Areas

• Develop gap analysis report on health inputs for primary health care
MSP: 83% delivery
• Develop an investment plan (based on the gap analysis above) to
guide the annual funding for implementing the minimum service
package for PHC facilities in the State

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3.5. Comparative Analysis: Scorecards 4, 5 and 6

3.5.1. Tool
Considering the emerging and re-emerging issues, the tool for Scorecard 4 was revised to
reflect new thinking and adequately measure establishment of individual criterion in PHCUOR
institutional framework in the scorecard 5 assessment.

3.5.2. Data analysis

For objective comparison, data for Scorecards 4 (SC4), 5 (SC5) and 6 (SC6) were analysed
to ensure similarity. This was necessary because in SC4, the MSP pillar score was an
aggregate of MSP criteria and health outcomes (referring to questions asked on health
outcomes). These results gave a false representation of states’ performance. For instance, a
state with little or no MSP criteria but with a high score in its health outcomes scored higher
than states with almost or all of the MSP criteria but low score on their health outcomes.

Furthermore, efforts to analyse the Scorecard 5 (SC5) data like that of Scorecard 4, that is,
inclusion of health outcomes in MSP pillar, posed a huge problem. Considering that the
establishment of PHCUOR institutional framework currently has no impact on health
outcomes, it was needful to measure only pillar criteria, in this case MSP pillar, to get the
actual representation of performance. Key stakeholders unanimously agreed to extract scores
on health outcomes from the computation of MSP pillar for Scorecard 4 since it was a stand-
alone in Scorecard 5, then compare only SC4 pillar criteria against SC5 and SC6 pillar criteria.
This provided an accurate representation of states’ progress with establishing the PHCUOR
institutional framework.

The SC6 results may begin to facilitate the shift from measuring establishment of framework
to actual evaluation of primary health care delivery and its impact on health outcomes in the
country.

Limitations of the comparative analysis:

• The tool used for Scorecard 6 assessment was adapted from Scorecard 5 tool
• Data collection process was modified
o The set of enumerators who conducted Scorecard 5 assessment may not be
the same as those for Scorecard 6, therefore, enumerator’s depth of knowledge
might impact data quality
o Quality control measures introduced in data collection for Scorecard 6 (SC6)
were absent in Scorecards 4 and 5:
▪ The SC6 tool was designed such that if a state answers ‘no’ to a critical
question, the tool skips to another pillar, this means that even if the
possess other components of the pillar but misses that critical
component it will not receive any scores
▪ Capturing of pictures of strategic documents that respondents claim
they possess during the assessment (using the electronic data
collection device), without which one cannot proceed to another
question
▪ Inclusion of questions to corroborate answers across the three levels
(state, LGA, facilities). For example, a question that a state answers
‘yes’ to and its LGHA and/or health facility answers ‘no’ automatically
nullifies the question for the state.

103
 • Data analysis: isolation of health outcomes from SC4 results may distort the printed
and disseminated overall scores. However, this was necessary for comparison. States
still maintain their SC4 scores.

These limitations may significantly impact the results and may have largely contributed to
disparity in the results, particularly for states with declining performance. Nevertheless,
Scorecard 5 shows an actual representation of the country’s performance with establishing
PHCUOR institutional framework and provides an appreciable representation of progress
made from 2018 to 2019. It is expected that Scorecard 6 will allow for better comparison.

Comparative Analysis Discussion

It is important to interpret the results bearing in mind that it reflects the level of establishing
the PHCUOR institutional framework. It does not in any way reflect the strength of primary
health care systems or health outcomes in Nigeria. It is expected that future scorecards will
begin to look at measures to evaluate actual PHC systems and its effect on health outcomes.

104
3.5.3. National Results

NATIONAL
SC4 SC5 SC6

86%

85%
84%

83%
81%

80%
79%
77%
77%
77%
74%

74%
73%

72%
72%

71%
64%
63%

63%
59%

58%
56%
55%
52%

47%
42%

7%

Figure 49: Comparison of national average performance across all pillars

At the national level, there has been appreciable improvement in the establishment of
PHCUOR institutional framework from 2018 to 2022. Most of the pillars recorded incremental
performance through the three scorecards (SC4, SC5, SC6) despite modification of the data
collection tools. This shows commitment of the NPHCDA and SPHCB leads in achieving
PHCUOR for improved health care delivery. On the average, Nigeria has recorded a 43%
performance increase since 2018 (SC4) in the establishment of PHCUOR framework. The
pillars driving this performance are MSP, Legislation and Repositioning. In 2018 (SC4), the
MSP pillar performance was 7% and in 2022 (SC6) the pillar recorded a score of 52% i.e., a
643% percentage increase. The highest performance increase across the pillars.
Nonetheless, the MSP pillar requires continued support as it remains the pillar with the lowest
scores when compared with other pillars. For the Repositioning pillar, one of the pain points
for states - transfer of Malaria, HIV/AIDS, TBL to SPHCB has been revised to reflect availability
of a desk officer for the respective programs in the SPHCB. This could have contributed to the
performance recorded in the pillar.

All pillars recorded significant average performance increase, except for Office Setup which
had a performance decline of -13%.

105
3.5.4. Zonal Results

SIX GEOPOLITICAL ZONE

SC4 SC5 SC6

86%
83%
82%
80%
76%

75%

72%
71%

71%

65%
65%

65%
65%
63%

59%

51%
47%

43%

41%
SOUTH EAST NORTH EAST NORTH CENTRAL NORTH WEST SOUTH WEST SOUTH SOUTH

Figure 43: Zonal performance across the period in view (SC4-6)- 2018-2022

At the zonal level, an average increase in performance of 52% was recorded. This
performance was largely driven by the South-South (68%), South-East (65%), North Central
(65%).

106
 3.5.5. State Results
65% 95%100%
82%
91%96%
0% 36%
38%
37%
63% 72%
82%
86% 95%
42% 74%
57%
36% 73%
54%
40% 60% 88%
46%
49% 65%
65% 86% 95%
64%

STATE PHCUOR PERFROMANCE 2018-2022

79% 92%
25% 68% 77%
40% 82%
82%
32% 79% 90%
30% 78%83%
67%
63% 72%
39% 63%
47%

SC4
71% 86%
49%
69% 92%98% SC5
56% 76% 85%
SC6

55% 72% 84%

45% 82% 98%
27%
24% 42%
36%
35%39%
47% 65% 82%
66% 78%
80%
63% 94%99%

40% 51%
26%
61% 81% 96%
58% 97%
87%
52%
55% 65%
42% 63% 99%
68% 78%
81%
62%
87% 96%
42% 49%
107

49%
80% 97%
96%
52% 76% 98%
Figure 51: States performance across the period in view (SC4-SC6) 2018-2022

The states have recorded year on year significant performance increase except for Ogun state
that has recorded consistent decline. Kogi and Kwara states have remained least performing
states across the period in view.

Table 31: States’ Scorecard from SC4-SC6 (2018-2022)

States SC4 SC5 SC6

Abia 65% 95% 100%

Anambra 37% 72% 63%
Ebonyi 64% 92% 79%
Enugu 32% 79% 90%
Imo 39% 63% 47%
Adamawa 82% 96% 91%
Bauchi 82% 86% 95%
Borno 40% 60% 88%
Gombe 67% 63% 72%
Taraba 42% 49% 49%
Yobe 80% 97% 96%
Benue 36% 73% 54%
FCT 30% 78% 83%
Kogi 27% 24% 42%
Kwara 36% 35% 39%
Nasarawa 66% 78% 80%
Niger 63% 94% 99%
Plateau 42% 63% 99%
Jigawa 71% 86% 49%
Kaduna 69% 92% 98%
Kano 56% 76% 85%
Katsina 55% 72% 84%
Kebbi 45% 82% 98%
Sokoto 62% 96% 87%
Zamfara 52% 76% 98%
Ekiti 40% 82% 82%
Lagos 47% 65% 82%
Ogun 51% 40% 26%
Ondo 61% 81% 96%
Osun 58% 97% 87%
Oyo 52% 65% 55%
Akwa Ibom 0% 36% 38%
Bayelsa 42% 74% 57%
Cross River 46% 49% 65%
Delta 65% 86% 95%
Edo 25% 68% 77%
108
Rivers 68% 78% 81%

Outstanding Performance

Legend:
90 – 100 Excellent Performance
50 – 89 Fair Performance
0 – 49 Poor Performance

109
3.5.6. State Comparative Discussion

SOUTH-EAST ZONE
ABIA STATE

Pillars SC4 SC5 SC6

Governance & 83% 100% 100%

Ownership
Legislation 75% 89% 100%
MSP 0% 100% 100%
Repositioning 67% 73% 100%
Systems 50% 100% 100%
Development
Human Resources 67% 100% 100%
Funding Sources 71% 100% 100%
Operational 100% 100% 100%
Guidelines
Office Set up 100% 100% 100%

Table 46: Abia State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

Abia State PHCUOR implementation has recorded significant leaps through the period in view,
with Scorecard 6 performance being the best and placing the state at the 1st position nationwide.
The table above shows the state’s commitment towards implementing PHCUOR including
addressing the issues within the Legislation, MSP, and Repositioning that posed the most
challenge to the state. Abia can be a model state for other states in the implementation of
PHCUOR.

Additionally, Abia state should begin to shift towards leveraging the full implementation of
PHCUOR to significantly improve the state’s health outcomes.

ANAMBRA STATE

Pillars SC4 SC5 SC6

Governance & 67% 75% 100%

Ownership
Legislation 63% 78% 91%
MSP 0% 55% 58%
Repositioning 11% 55% 56%
Systems 25% 43% 57%
Development
Human Resources 67% 63% 56%
Funding Sources 29% 100% 86%
Operational 67% 67% 67%
Guidelines
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 Office Set up 100% 67% 0%

Table 47: Anambra State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Anambra State PHCUOR implementation has recorded varied performance across the period
in view. Although the state performed the worst in SC4, its performance has continued to dwindle
as recorded in SC5 and SC6. For instance, the state’s performance in the Funding Sources pillar
leaped from 29% in SC4 to 100% in SC5, however, declined in SC6 by -14%. Additionally,
although, the state scored 100% in the Office Set up pillar in SC4, it recorded a sharp decline to
0% in the SC6. Anambra state should aim to fully implement PHCUOR by working on the
respective pillar pain points excluding the Governance & Ownership and Legislation pillars where
it surpassed the 90% expected target in SC6.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in addressing pain points across the
pillars with less than 90% score.

EBONYI STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 89%

Legislation 50% 89% 100%
MSP 20% 100% 100%
Repositioning 67% 91% 33%
Systems Development 63% 100% 86%
Human Resources 83% 88% 67%
Funding Sources 71% 86% 86%
Operational Guidelines 33% 100% 100%
Office Set up 67% 100% 50%

Table 48: Ebonyi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Ebonyi State PHCUOR implementation has recorded varied performance across the period
in view. Its best performance is recorded in pillars MSP and Operational Guidelines with a leap
from poor performance (SC4: 20% and 33% respectively) to excellent performance (100%: SC6).

Although the state performed the worst in SC4, its performance has continued to dwindle as
recorded in SC5 and SC6. For instance, the Repositioning pillar recorded a sharp decline (-58%)
in SC6 despite recording 91% score in SC5. Other pillars with declined performance are Office
Set up (-50%) and Governance & Ownership (-11%).

Ebonyi state should aim to fully implement PHCUOR by working on the respective pillar pain
points using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022), whilst
maintaining performance in the Legislation, MSP and Operational Guidelines pillar to ensure that
the pillars maintain 100% performance score for effective implementation of PHCUOR.

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ENUGU STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 100% 100%

Legislation 63% 89% 100%
MSP 0% 36% 75%
Repositioning 44% 73% 67%
Systems Development 0% 86% 86%
Human Resources 50% 75% 100%
Funding Sources 29% 100% 86%
Operational Guidelines 0% 0% 100%
Office Set up 0% 67% 100%

Table 49: Enugu State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Enugu State PHCUOR implementation has significantly improved over the period in view
save for the Funding Sources pillar that recorded a performance leap from 29% in SC4 to 100%
in SC5, however, it recorded a decline (-14%) in SC6. Its best performing pillars across are
Governance & Ownership, Legislation, Human Resources, Operational Guidelines (recorded a
significant leap from 0% in SC4 & SC5 to 100% in SC6), and Office Set up.

Enugu state should aim to fully implement PHCUOR by working on the MSP, Repositioning,
Systems Development, Funding Sources pillars using the revised PHCUOR Implementation
Guidelines (NPHCDA, 2022), whilst maintaining performance in the pillars with 100% scores.

IMO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 56%

Legislation 0% 78% 64%
MSP 0% 91% 92%
Repositioning 11% 36% 11%
Systems Development 63% 57% 43%
Human Resources 50% 88% 22%
Funding Sources 43% 29% 29%
Operational Guidelines 67% 100% 33%
Office Set up 100% 100% 75%

Table 50: Imo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Imo State PHCUOR implementation has recorded varied performance across the period in
view. Its best performance is recorded in the MSP pillar. However, the Operational Guidelines
pillar recorded a decline of -66% in SC6 despite having recorded a 33% performance increase in
SC5, when compared to SC4 performance. Other pillars with declined performance are
Governance & Ownership, Legislation and Office Set up. The Repositioning and Funding Sources
pillars have remained poor performing through the period in view. They should be prioritised
112
alongside Systems Development, Human Resources, Operational Guidelines pillars using the
revised PHCUOR Implementation Guidelines (NPHCDA, 2022), whilst improving other fair
performing pillars to achieve a 100% performance.

NORTH-EAST ZONE
ADAMAWA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 100%

Legislation 63% 67% 91%
MSP 40% 100% 67%
Repositioning 100% 100% 100%
Systems Development 88% 100% 86%
Human Resources 83% 100% 89%
Funding Sources 86% 100% 86%
Operational Guidelines 100% 100% 100%
Office Set up 100% 100% 100%

Table 51: Adamawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Adamawa State PHCUOR implementation has recorded varied performance across the
period in view. Its best performance is recorded in the Repositioning, Operational Guidelines and
Offices Set up pillars where it maintained a peak performance of 100% consistently from SC4 to
SC6. However, it recorded a decline in the MSP, Systems Development., Human Resources,
Funding Sources pillars.

Adamawa state should aim to fully implement PHCUOR by working on the pillars with declined
performance as listed above, whilst maintaining performance in the pillars with 100% performance
score for effective implementation of PHCUOR.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars with declined
performance.

BAUCHI STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 100%

Legislation 63% 56% 91%
MSP 60% 91% 100%
Repositioning 67% 73% 78%
Systems Development 88% 86% 100%
Human Resources 83% 75% 89%
113
 Funding Sources 100% 100% 100%
Operational Guidelines 33% 100% 100%
Office Set up 100% 100% 100%

Table 52: Bauchi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Bauchi State PHCUOR implementation has significantly improved over the period in view. Its
best performing pillars through the years are Governance & Ownership, MSP, Funding Sources,
Operational Guidelines (recorded a significant leap from 33% in SC4 to 100% in SC5 and SC6),
and Office Set up.

Bauchi state should aim to fully implement PHCUOR by working on the Repositioning and Human
Resources pillars using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022), whilst
maintaining performance in the pillars with 100% scores.

BORNO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 75% 100%

Legislation 0% 100% 91%
MSP 0% 0% 100%
Repositioning 56% 45% 78%
Systems Development 38% 71% 100%
Human Resources 50% 88% 89%
Funding Sources 43% 57% 100%
Operational Guidelines 100% 100% 100%
Office Set up 67% 100% 100%

Table 53: Borno State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Borno State PHCUOR implementation has significantly improved over the period in view. Its
best performing pillars through the years are Operational Guidelines (maintained a 100% score
through 2018 – 2022), Office Set up and Legislation. Comparing performance from SC4-SC6
shows that the MSP, Systems Development., Funding sources recorded a major leap from poor
performing pillar in the SC4 to one of the peak performing pillars.

Borno state should aim to fully implement PHCUOR by working on the Repositioning and Human
Resources pillars using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022), whilst
maintaining performance in the pillars with 100% scores.

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GOMBE STATE

Pillars SC4 SC5 SC6

Governance & Ownership 100% 25% 100%

Legislation 75% 44% 45%
MSP 20% 64% 0%
Repositioning 89% 82% 100%
Systems Development 50% 29% 86%
Human Resources 83% 63% 89%
Funding Sources 57% 86% 100%
Operational Guidelines 33% 33% 100%
Office Set up 100% 100% 25%

Table 54: Gombe State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Gombe State PHCUOR implementation has recorded varied performance across the period
in view. The state has recorded sharp declines in the Office Setup, Legislation and MSP pillars,
despite recording peak performance four out of its nine pillars.

Gombe state should prioritise the pillars with decline and aim to fully implement PHCUOR by
establishing all components of the pillars with less than 100% score in SC6; whilst maintaining
performance in the pillars with 100% performance score for effective implementation of PHCUOR.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars with declined
performance.

TARABA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 50% 78%

Legislation 63% 56% 45%
MSP 0% 55% 0%
Repositioning 56% 45% 56%
Systems Development 38% 57% 71%
Human Resources 67% 50% 56%
Funding Sources 14% 43% 71%
Operational Guidelines 67% 33% 67%
Office Set up 100% 67% 0%

115
Table 55: Taraba State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Taraba State PHCUOR implementation has recorded varied performance throughout the
period in view. None of its pillar met the expected 90% target and three (Legislation, MSP, Office
Set Up) out of its nine pillars recorded an average decline of -58%.

Taraba state should prioritise all the nine pillars and aim to fully implement PHCUOR using the
revised PHCUOR Implementation Guidelines (NPHCDA, 2022).

YOBE STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 75% 67%

Legislation 63% 100% 100%
MSP 40% 100% 100%
Repositioning 100% 100% 100%
Systems Development 88% 100% 100%
Human Resources 83% 100% 100%
Funding Sources 86% 100% 100%
Operational Guidelines 100% 100% 100%
Office Set up 100% 100% 100%

Table 56: Yobe State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Yobe State PHCUOR implementation has significantly improved over the period in view; with
peak performance in all its pillars excluding the Governance & Ownership pillar, which has
remained the least performing pillar from SC4-SC6. The pain points for the state are absence of
a governing Board with clear roles and responsibilities separate from that of the SPHCB
Management team, appropriate representation of the requisite groups in the Governing Board
(please refer to the revised PHCUOR Implementation Guidelines, 2022) and functionality of the
Governing Board including quarterly/biannual meetings.

Yobe state should aim to fully implement PHCUOR by establishing its Governing Board for the
SPHCB in accordance with the PHCUOR Implementation Guidelines (NPHCDA, 2022), whilst
maintaining performance in the pillars with 100% scores.

NORTH CENTRAL ZONE

BENUE STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 100% 78%

Legislation 25% 22% 27%
MSP 0% 45% 33%
Repositioning 44% 45% 78%
Systems Development 13% 71% 29%
Human Resources 50% 100% 56%
116
 Funding Sources 43% 100% 100%
Operational Guidelines 33% 100% 33%
Office Set up 100% 100% 50%

Table 57: Benue State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Benue State PHCUOR implementation has recorded varied performance throughout the
period in view. Its best performance is recorded in the Funding Sources pillar. It recorded declines
in over 70% of its pillars.

Benue state should aim to fully implement PHCUOR by working on all the PHCUOR pillars, whilst
maintaining performance in the Funding Sources pillar for effective implementation of PHCUOR.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars with declined
performance.

FEDERAL CAPITAL TERRITORY

Pillars SC4 SC5 SC6

Governance & Ownership 50% 50% 67%

Legislation 0% 100% 82%
MSP 0% 100% 100%
Repositioning 22% 45% 67%
Systems Development 75% 100% 71%
Human Resources 50% 88% 78%
Funding Sources 14% 71% 86%
Operational Guidelines 100% 100% 100%
Office Set up 100% 100% 100%

Table 58: FCT PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The FCT PHCUOR implementation has recorded varied performance throughout the period in
view. Its best performance is recorded in the Operational Guidelines, Office Setup and MSP
pillars. It recorded declines in three out of its nine pillars.

FCT should aim to fully implement PHCUOR by working on the pillars with less than 90% score
in SC6, whilst maintaining performance in the pillars with peak performance at 100%.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars with declined
performance.

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KOGI STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 13% 89%

Legislation 38% 78% 91%
MSP 0% 0% 0%
Repositioning 11% 9% 56%
Systems Development 25% 14% 14%
Human Resources 33% 25% 56%
Funding Sources 29% 29% 71%
Operational Guidelines 0% 33% 0%
Office Set up 0% 33% 0%

Table 59: Kogi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Kogi State PHCUOR implementation has been epileptic since the inception of PHCUOR
scorecard assessments. The state requires immediate technical assistance for optimal
implementation of PHCUOR.

Kogi state should aim to fully implement PHCUOR by working on all its pillars using the revised
PHCUOR Implementation Guidelines (NPHCDA, 2022).

KWARA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 25% 33%

Legislation 38% 33% 45%
MSP 0% 0% 0%
Repositioning 11% 45% 33%
Systems Development 25% 29% 29%
Human Resources 33% 38% 33%
Funding Sources 43% 57% 71%
Operational Guidelines 67% 0% 33%
Office Set up 67% 0% 75%

Table 60: Kwara State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Kwara State PHCUOR implementation has been extremely poor since the inception of
PHCUOR scorecard assessments. The state requires immediate technical assistance for optimal
implementation of PHCUOR.

Kwara state should aim to fully implement PHCUOR by working on all its pillars using the revised
PHCUOR Implementation Guidelines (NPHCDA, 2022).

118
NASARAWA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 75% 67%

Legislation 38% 56% 91%
MSP 0% 73% 0%
Repositioning 67% 73% 89%
Systems Development 75% 71% 86%
Human Resources 83% 75% 100%
Funding Sources 86% 100% 86%
Operational Guidelines 67% 33% 100%
Office Set up 100% 67% 100%

Table 61: Nasarawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Nasarawa State PHCUOR implementation has recorded varied performance throughout the
period in view. The MSP pillar has continued to be a challenge for the state.

Nasarawa state should aim to fully implement PHCUOR by working on all the PHCUOR pillars
with less than 100% score, whilst maintaining performance in the pillars with 100% scores.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars with declined
performance.

NIGER STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 100% 100%

Legislation 50% 89% 100%
MSP 0% 82% 92%
Repositioning 56% 82% 100%
Systems Development 75% 100% 100%
Human Resources 83% 100% 100%
Funding Sources 71% 100% 100%
Operational Guidelines 67% 100% 100%
Office Set up 100% 100% 100%

Table 62: Niger State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Niger State PHCUOR implementation has significantly improved over the period in view; with
peak performance in almost all its pillars. The MSP pillar is yet to attain peak performance of
100%.

119
Niger state should aim to fully implement PHCUOR by disseminating the approved costed MSP
state wide (state, LGHA, health facility), whilst maintaining performance in the pillars with 100%
scores.

PLATEAU STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 63% 100%

Legislation 38% 78% 100%
MSP 0% 73% 92%
Repositioning 33% 55% 100%
Systems Development 25% 43% 100%
Human Resources 50% 50% 100%
Funding Sources 57% 71% 100%
Operational Guidelines 33% 0% 100%
Office Set up 0% 67% 100%

Table 63: Plateau State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Plateau State PHCUOR implementation has significantly improved over the period in view,
with peak performance in almost all its pillars. The MSP pillar is yet to attain peak performance of
100%.

Plateau state should aim to fully implement PHCUOR by ensuring availability of documentation
on gap analysis between the proposed health inputs approved in the MSP document and status
quo, whilst maintaining performance in the pillars with 100% scores.

NORTH-WEST ZONE
JIGAWA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 75% 100%

Legislation 50% 75% 64%
MSP 0% 82% 0%
Repositioning 56% 73% 33%
Systems Development 88% 100% 57%
Human Resources 83% 88% 67%
Funding Sources 86% 100% 86%
Operational Guidelines 100% 100% 33%
Office Set up 100% 100% 0%

Table 64: Jigawa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

120
The Jigawa State PHCUOR implementation has recorded varied performance throughout the
period in view. Over 90% of its pillars recorded a decline in SC6, Governance & Ownership is the
best performing pillar at 100%. Other pillars require immediate attention.

Jigawa state should aim to fully implement PHCUOR by prioritising all the PHCUOR pillars, whilst
maintaining performance in the Governance & Ownership pillar.

Additionally, to maintain consistency in performance improvement, the revised PHCUOR

Implementation Guidelines (NPHCDA, 2022) should be used in improving the pillars.

KADUNA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 100%

Legislation 38% 67% 100%
MSP 20% 100% 100%
Repositioning 67% 73% 89%
Systems Development 63% 100% 100%
Human Resources 83% 100% 89%
Funding Sources 86% 100% 100%
Operational Guidelines 67% 100% 100%
Office Set up 100% 100% 100%

Table 65: Kaduna State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Kaduna State PHCUOR implementation has recorded varied performance though largely
improved. However, one (Human Resources) out of the nine pillars recorded a -11% decline.

Kaduna state should aim to fully implement PHCUOR by ensuring the transfer of all RMNCAEH+N
programmes to the SPHCB (Repositioning) and engage or recruit {by transfer or secondment)
requisite number of staff to fill identified HRH gaps at SPHCB and LGHAs (Human Resources),
whilst maintaining performance in the pillars with 100% scores.

KANO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 75% 100%

Legislation 25% 56% 100%
MSP 0% 100% 100%
Repositioning 33% 36% 100%
Systems Development 100% 100% 100%
Human Resources 67% 75% 89%
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 Funding Sources 71% 86% 100%
Operational Guidelines 0% 100% 0%
Office Set up 100% 67% 75%

Table 66: Kano State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Kano State PHCUOR implementation has recorded significant improvement through the
period in view. However, it recorded a sharp decline on the Operational Guidelines pillar from
100% in SC5 to 0% in SC6, despite the significant leap from 0% in SC4 to 100% in SC5.

Kano state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

KATSINA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 50% 100%

Legislation 63% 78% 100%
MSP 0% 73% 0%
Repositioning 56% 45% 67%
Systems Development 50% 86% 100%
Human Resources 50% 75% 89%
Funding Sources 71% 86% 100%
Operational Guidelines 0% 67% 100%
Office Set up 100% 67% 100%

Table 67: Katsina State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Katsina State PHCUOR implementation has recorded varied performance in the period in
view. The MSP pillar requires immediate attention, also the Repositioning and Operational
Guidelines pillar components should be established.

Katsina state should aim to fully implement PHCUOR by addressing all the components under
the pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

KEBBI STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 75% 100%

Legislation 38% 67% 100%
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 MSP 0% 55% 100%
Repositioning 22% 91% 100%
Systems Development 63% 100% 100%
Human Resources 33% 100% 100%
Funding Sources 57% 86% 86%
Operational Guidelines 67% 100% 100%
Office Set up 100% 100% 100%

Table 68: Kebbi State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Kebbi State PHCUOR implementation has recorded significant improvement through the
period in view. Its best performing pillar is Office Set up which has maintained a peak performance
from SC4 through SC6.

Kebbi state should aim to fully implement PHCUOR by ensuring that all PHC staff (SPHCB and
LGHAs) are on the payroll of the SPHCB, whilst maintaining performance in the pillars with peak
performance using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022).

SOKOTO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 89%

Legislation 50% 100% 82%
MSP 0% 100% 100%
Repositioning 78% 73% 100%
Systems Development 50% 100% 100%
Human Resources 67% 100% 89%
Funding Sources 71% 100% 86%
Operational Guidelines 67% 100% 67%
Office Set up 67% 100% 75%

Table 69: Sokoto State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Sokoto State PHCUOR implementation has recorded varied performance in the period in
view, with declines across six out of its nine pillars.

Sokoto state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

ZAMFARA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 75% 100%

Legislation 75% 100% 100%

123
 MSP 0% 55% 83%
Repositioning 56% 73% 100%
Systems Development 88% 100% 100%
Human Resources 83% 75% 100%
Funding Sources 29% 71% 100%
Operational Guidelines 67% 67% 100%
Office Set up 100% 67% 100%

Table 70: Zamfara State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Zamfara State PHCUOR implementation has significantly improved over the period in view,
with peak performance in almost all its pillars. The MSP pillar is yet to attain peak performance of
100%.

Zamfara state should aim to fully implement PHCUOR by ensuring documentation on gap analysis
between the proposed health inputs and status quo; also ensure availability of an investment plan
(based on the gap analysis above) to guide the annual funding for implementing the minimum
service package for PHC facilities in the State, whilst maintaining performance in the pillars with
100% scores.

SOUTH-WEST ZONE
EKITI STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 88% 89%

Legislation 38% 100% 100%
MSP 0% 36% 0%
Repositioning 11% 100% 89%
Systems Development 75% 57% 86%
Human Resources 50% 75% 100%
Funding Sources 43% 100% 100%
Operational Guidelines 0% 67% 100%
Office Set up 100% 67% 75%

Table 71: Ekiti State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Ekiti State PHCUOR implementation has recorded varied performance in the period in view.
The MSP pillar requires immediate attention, as it’s the worst performing pillar.

Ekiti state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

124
LAGOS STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 50% 100%

Legislation 38% 67% 100%
MSP 0% 0% 0%
Repositioning 22% 45% 78%
Systems Development 50% 71% 86%
Human Resources 67% 100% 100%
Funding Sources 57% 100% 100%
Operational Guidelines 100% 67% 100%
Office Set up 100% 67% 75%

Table 72: Lagos State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Lagos State PHCUOR implementation has recorded varied performance in the period in view.
The MSP pillar requires immediate attention, as it’s the worst performing pillar.

Lagos state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

OGUN STATE

Pillars SC4 SC5 SC6

Governance & Ownership 33% 25% 33%

Legislation 38% 56% 64%
MSP 0% 9% 0%
Repositioning 56% 45% 44%
Systems Development 63% 14% 29%
Human Resources 67% 13% 22%
Funding Sources 57% 71% 43%
Operational Guidelines 67% 0% 0%
Office Set up 100% 67% 0%

Table 73: Ogun State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

Ogun State requires immediate intervention in the implementation of PHCUOR. Through the
period in view, the state PHCUOR implementation has been extremely poor.

The revised PHCUOR Implementation Guidelines (NPHCDA, 2022) should be used as a

companion as the state works towards optimising primary health care under one roof.

125
ONDO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 0% 75% 67%

Legislation 25% 78% 100%
MSP 40% 91% 100%
Repositioning 100% 64% 100%
Systems Development 88% 86% 100%
Human Resources 83% 75% 100%
Funding Sources 57% 86% 100%
Operational Guidelines 100% 100% 100%
Office Set up 100% 100% 100%

Table 74: Ondo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Ondo State PHCUOR implementation has significantly improved over the period in view, with
peak performance in almost all its pillars. The Governance & Ownership pillar is yet to attain peak
performance of 100%.

Ondo state should aim to fully implement PHCUOR by constituting a Governing Board for the
SPHCB with clear roles and responsibilities separate from that of the management team. The
Governing Board must be established in accordance with the PHCUOR implementation guide to
ensure appropriate representation across the state and functionality, whilst maintaining
performance in the pillars with 100% scores.

OSUN STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 100%

Legislation 25% 89% 73%
MSP 0% 91% 100%
Repositioning 67% 100% 100%
Systems Development 75% 100% 86%
Human Resources 67% 100% 89%
Funding Sources 57% 100% 100%
Operational Guidelines 100% 100% 33%
Office Set up 100% 100% 100%

Table 75: Osun State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Osun State PHCUOR implementation has recorded varied performance in the period in view.
The Operational Guidelines pillar requires immediate attention, as it’s the worst performing pillar.

Osun state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.
126
OYO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 33% 38% 78%

Legislation 38% 78% 45%
MSP 0% 82% 0%
Repositioning 56% 64% 67%
Systems Development 50% 43% 57%
Human Resources 50% 75% 44%
Funding Sources 71% 71% 71%
Operational Guidelines 33% 0% 33%
Office Set up 100% 33% 100%

Table 76: Oyo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

Oyo state requires technical assistance in the implementation of PHCUOR as most of its pillars
continue to perform sub optimally throughout the period in view.

The revised PHCUOR Implementation Guidelines (NPHCDA, 2022) should be used as a

companion as the state works towards optimising primary health care under one roof.

SOUTH-SOUTH ZONE
AKWA IBOM STATE

Pillars SC4 SC5 SC6

Governance & Ownership 0% 88% 67%

Legislation 0% 56% 0%
MSP 0% 0% 0%
Repositioning 0% 9% 44%
Systems Development 0% 0% 14%
Human Resources 0% 25% 67%
Funding Sources 0% 57% 43%
Operational Guidelines 0% 0% 33%
Office Set up 0% 67% 75%

Table 77: Akwa-Ibom State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

Akwa-Ibom state started implementation of PHCUOR later than other states and would require
technical assistance to catch up and fully implement PHCUOR.

The revised PHCUOR Implementation Guidelines (NPHCDA, 2022) should be used as a

companion as the state works towards optimising primary health care under one roof.

127
BAYELSA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 75% 56%

Legislation 75% 78% 73%
MSP 0% 9% 0%
Repositioning 0% 91% 67%
Systems Development 38% 57% 57%
Human Resources 33% 75% 33%
Funding Sources 57% 100% 86%
Operational Guidelines 33% 100% 67%
Office Set up 100% 67% 75%

Table 78: Bayelsa State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Bayelsa State PHCUOR implementation has recorded varied performance in the period in
view. The MSP and Human Resources pillars require immediate attention, as they are the worst
performing pillars.

Bayelsa state should aim to fully implement PHCUOR by addressing the components under all its
nine pillars using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022).

CROSS RIVER STATE

Pillars SC4 SC5 SC6

Governance & Ownership 67% 38% 56%

Legislation 50% 56% 55%
MSP 20% 55% 83%
Repositioning 22% 45% 89%
Systems Development 25% 29% 57%
Human Resources 67% 50% 67%
Funding Sources 57% 67% 86%
Operational Guidelines 0% 67% 67%
Office Set up 100% 33% 25%

Table 79: Cross River State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Cross River State PHCUOR implementation has recorded minimal performance improvement
in the period in view.

Cross River state should aim to fully implement PHCUOR by addressing components under all its
nine pillars using the revised PHCUOR Implementation Guidelines (NPHCDA, 2022).

128
DELTA STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 100% 100%

Legislation 38% 89% 100%
MSP 0% 18% 92%
Repositioning 100% 100% 100%
Systems Development 75% 86% 100%
Human Resources 83% 100% 100%
Funding Sources 57% 100% 86%
Operational Guidelines 100% 100% 100%
Office Set up 100% 100% 75%

Table 80: Delta State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Delta State PHCUOR implementation has significantly improved over the period in view, with
peak performance in almost all its pillars. The Funding Sources and Office Set up pillars are yet
to attain peak performance of 100%.

Delta state should aim to fully implement PHCUOR by addressing the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

EDO STATE

Pillars SC4 SC5 SC6

Governance & Ownership 50% 100% 100%

Legislation 25% 44% 91%
MSP 0% 0% 0%
Repositioning 0% 82% 89%
Systems Development 13% 86% 71%
Human Resources 50% 100% 100%
Funding Sources 29% 71% 100%
Operational Guidelines 33% 100% 67%
Office Set up 67% 100% 75%

Table 81: Edo State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Edo State PHCUOR implementation has recorded varied performance in the period in view.
The MSP pillar requires immediate attention, as it’s the worst performing pillar.

Edo state should aim to fully implement PHCUOR by addressing all the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

129
RIVERS STATE

Pillars SC4 SC5 SC6

Governance & Ownership 83% 88% 67%

Legislation 38% 78% 91%
MSP 0% 73% 0%
Repositioning 44% 45% 89%
Systems Development 88% 100% 100%
Human Resources 83% 75% 100%
Funding Sources 71% 86% 86%
Operational Guidelines 67% 100% 100%
Office Set up 67% 100% 100%

Table 82: Rivers State PHCUOR Performance: Scorecards 4, 5, 6 (2018-2022)

The Rivers State PHCUOR implementation has significantly improved over the period in view,
although its MSP pillar recorded a -73% sharp decline.

Rivers state should aim to fully implement PHCUOR by addressing the components under the
pillars with less than 100% score using the revised PHCUOR Implementation Guidelines
(NPHCDA, 2022), whilst maintaining performance in the pillars with peak performance.

130
ANNEX 1: PHCUOR SCORECARD 6 TOOL

131
 2022 PHCUOR SCORECARD 6 TOOL FOR ASSESSMENT OF THE
FUNCTIONALITY OF STATE PRIMARY HEALTH CARE BOARDS (SPHCBs)
Details
State Assessed: ______________________________ Date of Assessment
_______________dd/mm/yy
Assessors
1) Name _______________________________ Organization __________________ Phone
No_______________
2) Name _______________________________ Organization __________________Phone
No_____________
3) Name ______________________________ Organization __________________Phone
No____________________
4) Name ______________________________ Organization _________________ Phone
No______________
5) Name ______________________________ Organization __________________Phone
No______________

Response
S/N Questions Notes
Yes No

A. PHCUOR Pillars
1 GOVERNANCE AND OWNERSHIP
Tick YES if there is a substantive ES and
Is there a management team in place (headed by a substantive directors for the SPHCB. No if
1.1 either the ES or the directors are not in
substantive Executive Secretary) for the SPHCB?
B place.
Is there a Governing Board for the SPHCB with clear Tick YES if there is a Governing Board with
1.2 roles and responsibilities separate from that of the a part-time chairman and members with
B management team? defined roles and responsibilities.

Does the Governing Board include representatives Tick YES if the SPHCB Governing Board
1.3 from at least all of the following: SMoH, SMoLG, has representatives from ALL of the
ALGON and a Women Group? institutions/groups.

Did the Governing Board meet at least once in the last Tick YES if the Governing Board met at
1.4 least once in the last 6 months.
6 months?

Is there a LG Health Authority (LGHA) in every LGA Tick YES if there exists a LGHA in every
1.5 LGA reporting to the SPHCB.
reporting to the SPHCB?

132
 Tick YES if the SPHCB has constituted LG
Advisory Committees headed by the LGA
Is there a LG Advisory Committee headed by the LGA
1.6 Chairmen for all LGHAs in the State and all
Chairman for every LG Health Authority in the State? the LG Advisory Committees have each
met at least once in the past 6 months.

Tick YES if there is a LGHA Management

Team headed by the LG Health Secretary
Is there a LGHA Management Team in each of the LG in each of the LG Health Authorities in the
1.7 State. (refer to PHCUOR Management
health authorities?
guideline for composition of management
team )
Tick YES if there is a list of WDC
Does the SPHCB have functional Ward Development
1.8 membership for all the wards in the State.
Committees (WDCs) in all the wards in the state? (Sight and snap the list)
Is there a Facility Management Committee (FMC) in Tick YES if there is a list of Facility
1.9 each of the ward focal Primary Health Centres in the Management Committee members for
State? each of the ward focal PHCs.
2 LEGISLATION
Is there an SPHCB Law (i.e. a bill passed by the State Tick YES if there is a copy of the signed
SPHCB Law. (Sight and snap the cover
2.1 House of Assembly, signed into Law by the Executive
page and signature page of the Governor)
Governor and gazetted) for the SPHCB?
Does the SPHCB Law have provision for the Tick YES if there is provision in the
SPHCB Law for the transformation of all
transformation of LGA PHC departments in all LGAs
2.2 PHC departments to LG Health
of the State to LG Health Authorities (LGHAs) Authorities. (Sight and snap the relevant
reporting to the SPHCB? page)
Tick YES if there is provision in the
Does the SPHCB Law have provision for the SPHCB Law for the formation/reactivation
2.3 formation/reactivation and roles & responsibilities of of Ward Development Committees in each
Ward Development Committees (WDCs)? political ward. (Sight and snap the
relevant page)
Does the SPHCB Law have provision that clearly Tick YES if there is provision in the
2.4 separates the roles of the Governing Board from that SPHCB Law that covers this requirement.
of the management team? (Sight and snap the relevant page)

Does the SPHCB Law have a clear provision on the Tick YES if there is provision in the
2.5 oversight role of the SMoH including reporting line SPHCB Law that covers this requirement.
from the ES SPHCB to Commissioner of Health? (Sight and snap the relevant page)
Does the SPHCB Law provide for the movement of
Tick YES if there is provision in the
PHC departments, PHC staff, PHC programmes and
2.6 SPHCB Law that covers this requirement?
PHC funds in all LGAs in the State to the LGHAs and (Sight and snap the relevant page)
SPHCB?
Tick YES if there is provision in the
Does the SPHCB Law have provision for the transfer
2.7 SPHCB Law that covers this requirement.
of all PHC facilities in the State to the SPHCB? (Sight and snap the relevant page)

Does the SPHCB Law have clear provision for the

Tick YES if there is provision in the
development of a costed and approved Minimum
2.8 SPHCB Law that covers this requirement.
Service Package (MSP) document for service delivery (Sight and snap the relevant page)
in all PHC facilities in the State?

133
 Does the SPHCB Law have clear provisions for Tick YES if there is provision in the
SPHCB Law that covers this
2.9 recruitment, human resources management and requirement.(Sight and snap the relevant
control in line with the PHCUOR principles? page)

Does the SPHCB Law have clear provisions for the Tick YES if there is provision in the
2.1 different sources of funding and expected SPHCB Law that covers this requirement.
contributions of the State and LGAs to the SPHCB? (Sight and snap the relevant page)
Tick YES if there is a copy of the
Is there Regulations for operationalizing the SPHCB Regulations signed by either the HCoH or
2.11 Executive Governor (Sight and snap the
Law?
front page of the document)
3 MINIMUM SERVICE PACKAGE (MSP)
Has the SPHCB developed a minimum service Tick YES if there is an MSP document
3.1 package document, approved by the Governor, and approved by the State Government. (Sight
printed? and snap the front page of the document)
Tick YES if there is provision for the
Does the MSP document provide guidance for the typology/ classification in the MSP
3.2 document. (Sight and snap the relevant
classification/typology of PHC facilities in the State?
page)
Tick YES if there is a list of all PHC
Have all the PHC facilities in the State been classified facilities in the State classified according
3.3 to the national guidelines. (Sight and snap
according to the MSP guidelines?
the relevant page)
Tick YES if there is provision in the MSP
Does the MSP document define the minimum service document for the minimum service
3.4 expected at each facility type. (Sight and
expected at each facility type?
snap the relevant page)

Does the MSP document define the minimum Tick YES if there is provision in the MSP
document for the minimum resources
3.5 resources (HRH, infrastructure, equipment, medicines expected at each facility type. (Sight and
and consumables) expected at each facility type? snap the relevant page)
Tick YES if the MSP is costed. (Sight and
3.6 Is the MSP document costed? snap the relevant page)
Is there at least one fully functional PHC in every ward
Tick YES if at least one fully functional
3.7 in the state? (PHC facility operates 24hrs service, with facility exists in all the wards of the State
requisite human resources, electricity, water supply)
Is there a documentation on gap analysis between the Tick YES if there is a documentation on
proposed HRH, Infrastructure, equipment and gap analysis between resources proposed
3.8 by the MSP and what is available (Sight
services approved in the MSP document and what is
currently on ground? and snap the relevant page)
Is there an investment plan (based on the gap Tick YES if there is an investment or
analysis above) to guide the annual funding for service delivery plan. (Sight and snap the
3.9 relevant page)
implementing the minimum service package for PHC
facilities in the State?
Does the MSP costing and investment plan take Tick YES if the MSP costing and
3.1 cognizance of the State's finances i.e. fiscal space investment plan was done within the
analysis of the State context of the State fiscal space

Is there provision in the current annual budget for the

Tick YES if there is provision in the State
3.12 proposed interventions in the investment plan outlined annual budget for the year
for the corresponding year?

134
 Tick YES if the MSP document has been
disseminated to all key stakeholders
Has the MSP document been disseminated to all key (especially the key stakeholders that were
3.13 involved in developing the MSP
stakeholders, LGHAs and PHC facilities in the State.?
document), LGHAs and PHC facilities in
the State
4 REPOSITIONING
Tick YES if the PHC department, all PHC
Have the PHC department and staff in the State staff, all PHC programmes and all PHC
4.1 Ministry of Health (SMoH) been moved to the funds have been moved to the SPHCB.
SPHCB? Tick No if there is still a PHC Department
in the SMoH.
Have the PHC department and all PHC staff in the Tick YES if the PHC department and all
PHC staff have been moved to the
4.2 State Ministry of Local Government (SMoLG) been SPHCB. Tick No if there is still a PHC
moved to the SPHCB? Department in the SMoLG.
Have the LGA PHC departments in all LGAs of the
State been transformed into the Local Government Tick YES if there is a LGHA in each of the
4.3 LGAs. Else tick No
Health Authorities (LGHAs) with clear reporting line to
the SPHCB?
Have all RMNCAEH+N programmes been moved to Tick YES if all RMNCAEH+N programmes
4.4 have been moved to the SPHCB.
the SPHCB?
Has the Immunization programme been moved to the Tick YES if the Immunization programme
4.5 has been moved to the SPHCB.
SPHCB?
Is there a Malaria programme focal person in the Tick YES if the Malaria Programme has
4.6 been moved to the SPHCB.
SPHCB?
Is there a HIV/AIDs programme focal person in the Tick YES if the HIV/AIDS Programme has
4.7 been moved to the SPHCB.
SPHCB?
Is there a TBL programme focal person in the Tick YES if the TBL Programme has been
4.8 moved to the SPHCB.
SPHCB?
Have there been an orientation and reorientation of Tick YES if the SPHCB has conducted an
orientation for the key staff on the roles
the key staff of the LGHAs on the roles and
4.9 and responsibilities of the SPHCB, LGAs
responsibilities of the SPHCB, LGAs and LGHAs in and the LGHAs in the past 6 months.
the past 6 months? (Sight evidence of orientation)
5 SYSTEMS DEVELOPMENT
Tick YES if the current State Strategic
Health Development Plan incorporates the
Does the State Strategic Health Development Plan
5.1 MSP and Investment plan. Insert NA if the
incorporate the MSP and investment plan? SSHDP precedes the development of the
MSP
Does each of the LGHAs in the State have an LGHA Tick YES if ALL the LGHAs have a current
5.2 (2022) Annual Operational Plan.
PHC Annual Operational Plan?
Is there a State PHC Annual Operational Plan (AOP) Tick YES if there is a current (2022} State
5.3 with budget incorporating all LGHA Annual PHC Annual Operational Plan (AOP)
Operational Plans? developed by the SPHCB.
Tick YES if there is a current
Is there an M&E/result/performance framework with
5.4 M&E/result/performance framework/ for
clear milestones and targets for the SPHCB? the State.
Tick YES if there is a list of State ISS
Is there a functional Integrated Supportive Supervision
5.5 team, LGHA ISS teams, ISS plan and last
(ISS) plan for the SPHCB? quarter ISS report.

135
 Has there been a central quarterly performance Tick YES if at least one performance
review has been conducted in the past 6
5.6 review for the SPHCB involving stakeholders from the months with participants from the SPHCB
SPHCB/LGHA/HF and LGHAs with results available.
Is there a functional data quality assurance system in Tick YES if the State conducted a State-
5.7 wide DQA exercise in the past 6 months
place?
6 HUMAN RESOURCES
Is there a distinct unit or department for Human Tick YES if there is a HRH unit or
6.1 department in the SPHCB
Resources for Health in the SPHCB?
Is there a job description for every position in the Tick YES if there is a job description for
6.2 every position in the SPHCB (Sight)
SPHCB?
Is there a job description for every position in the Tick YES if there is a job description for
6.3 every position in the LGHAs (Sight)
LGHAs?
Tick YES if there is a job description for
Is there a job description for every position in the
6.4 every position in the health facility
health facility management team? management team (Sight)
Tick YES if there is an up-to-date nominal
Is there an up-to-date nominal roll with the names of roll with the names of all SPHCB and
6.5
all SPHCB and LGHAs staff? LGHAS staff (Sight)
Is there a functional Human Resources Information Tick YES if there is a comprehensive and
6.6 System (HRIS) for Human Resources for Health up-to-date database for HRH planning in
(HRH) Planning in the SPHCB? the SPHCB

Is there an up-to-date Human Resources for Health Tick YES if there is an up-to-date HRH
6.7 (HRH) Plan to fill identified HRH gaps at the SPHCB Plan to fill identified HRH gaps at SPHCB
and LGHAs? and LGHAs
Has SPHCB engaged or recruited {by transfer or Tick YES if new staff have been engaged
secondment) required staff in the last 12 months to fill or recruited (by transfer or secondment) in
6.7
identified HRH gaps at SPHCB and LGHAs? the last 12 months to fill identified HRH
gaps in the SPHCB and LGHAs
Is there a process in place for onboarding new staff of Tick YES if all the SPHCB staff
the SPHCB? (engaged/posted in the last 12 months)
6.8 have been onboarded (received
orientation) (if YES sight report)
7 FUNDING SOURCES & STRUCTURE
Is there a dedicated budget line for PHC Tick YES if there is a budget line for PHC
7.1 implementation in the approved 2022 State implementation in the approved 2022
budget? annual State budget.
Is there a dedicated budget line for PHC Tick YES if there is a budget line for PHC
7.2 implementation in the approved 2022 LGA implementation in the approved 2022
LGA budget? annual LGA budget (of sampled LGAs).

Is there a dedicated bank account for the SPHCB Tick YES if there a dedicated bank
7.3 with all the signatories drawn from the SPHCB account for the SPHCB with all signatories
management team? drawn from the management team.

Does each LGHA have a dedicated bank account Tick YES if there a list of dedicated bank
7.4 with signatories from the LGHA management accounts with names of signatories for
LGA team? each LGHA
Are all PHC staff (SPHCB and LGHAs) on the payroll Tick YES if all PHC staff (SPHCB and
7.5 LGHAs) are on the payroll of the SPHCB
of the SPHCB?

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 Tick YES if there is a document showing
Is there a functional system for regular tracking of
7.6 regular analysis of budget performance.
PHC income and expenditure? (Sight document)
Tick YES if there is an audited report of
Is there a published consolidated audited report of
7.7 PHC income and expenditure for the
PHC income and expenditure for the preceding year? preceding year.(Sight document)
8 OPERATIONAL GUIDELINES
Has the State disseminated the PHCUOR Tick YES if the PHCUOR Implementation
Implementation Guidelines to all staff at SPHCB and Guidelines has been distributed to at least
LGHAs? ALL members of the Governing Board and
8.1 management team in the SPHCB and
members of LG Advisory Committee and
management team in the LGHAs.
Is there an SPHCB Operational Guidelines for
administrative procedures (HR, Admin, Logistics, Tick YES if there is an SPHCB
8.2 Operational Guidelines. (Sight)
Finance & Accounts, Procurement etc)

Have key personnel (management team of SPHCB Tick YES if ALL members of the
management team at SPHCB and LGHA
and LGHAs) received orientation on the mandate,
8.3 levels have received orientation using the
mission, vision and new/emerging PHC issues using SPHCB Operational Guidelines. (Sight
the SPHCB Operational Guidelines? orientation report)
9 OFFICE SET-UP
Tick YES if the SPHCB has a clearly
Does the SPHCB have an independent, clearly
9.1 signposted permanent building allocated
signposted and permanent office building? to it as office.
Does the SPHCB office building have at least internet Tick YES if the SPHCB office building has
9.2 access, computers, printers, portable water, power more than half (at least four) of all the
and power backup? facilities listed.
Tick YES if the SPHCB has office
Does the SPHCB have office space, basic computer
space, basic computer and printer for
9.3 and printer for each of the members of the
each of the members of the
management team?
management team.
Tick YES if ALL LGHAs in the State have
Does each LGHA have an independent, clearly
9.4 clearly signposted permanent buildings
signposted and permanent office building? allocated as office buildings.

B- PHC Service Delivery Outcomes

Tick YES if the cumulative facility report
Is the monthly HMIS facility reporting rate more than
B1 80%?
for the last 12 months is greater than 80%
on the DHIS2
Is there a decreasing trend in the number of Tick YES if there is a decreasing trend in
B2 institutional maternal deaths in the preceding 12 facility maternal deaths based on DHIS2
months? data in the preceding 12 months.
Tick YES if there is a decreasing trend in
Is there a decreasing trend in the number of
B3 institutional stillbirths in the preceding 12 months?
facility stillbirths based on DHIS2 data in
the preceding 12 months.
Is there a decreasing trend in the number of Tick YES if there is a decreasing trend in
B4 institutional neonatal deaths in the preceding 12 facility neonatal deaths based on DHIS2
months? data in the preceding 12 months.
Is there a decreasing trend in the number of Tick YES if there is a decreasing trend in
B5 institutional under five deaths in the preceding 12 facility under-five deaths based on DHIS2
months? data in the preceding 12 months.

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 Is there a decreasing trend in the number of Tick YES if there is a decreasing trend in
B6 institutional under-fives who are underweight in the facility maternal deaths based on DHIS2
preceding 12 months? data in the preceding 12 months.
Tick YES if there is an increasing trend in
new acceptors of contraceptives in
B7 Is there an increasing trend in contraceptive use? facilities based on DHIS2 data in the
preceding 12 months.
Is there a decreasing trend in the number of zero Tick YES if there is a decreasing trend in
B8
dose? number of zero dose children in the State

C: Challenges and Recommendation (List only three) - challenges with implementing PHCUOR
SN Problems Recommendations

C1

C2

C3

D: Implementation of LGA Financial Autonomy

D1 How has the implementation of the LGA financial autonomy affected the SPHCB on: (i) Payment of
staff salaries and allowance and (ii) Joint funding of SPHCB by State Government and all LGAs.
Comments:

EDITORIAL TEAM

S/N Names Organization

1 Uche Eberi CSDFoundation

2 Mr. Adeniyi Ekisola NPHCDA

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REFERENCES

MICS. (2021). Abuja: National Bureau of Statistics. Retrieved September 21, 2018, from Nigeria
MICS-NICS 2021 report rev 2 (unicef.org)

NPC. (2018). 2018 Nigeria Demographic and Health Survey: Key Indicators Report. Abuja:
National Population Commission

NPC. (2006). 2006 Population and Housing Census of the Federal Republic of Nigeria: National
and State Population and Housing Census Priority Tables. Abuja: National Population
Commission

NPHCDA (2018). Implementation Status of Primary health Care Under One Roof (PHCUOR):
Scorecard 4. Abuja: National Primary Health Care Development Agency

NPHCDA (2019). Implementation Status of Primary health Care Under One Roof (PHCUOR):
Scorecard 5. Abuja: National Primary Health Care Development Agency

NPHCDA (2022). Primary health Care Under One Roof (PHCUOR) Implementation Guidelines.
Abuja: National Primary Health Care Development Agency

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