"The ground is softening" for the USAID/Nigeria health portfolio : considerations for the present and the future

For the last several years funds available for USAID"s RH/FP program averaged an operating year budget (OYB) of $10-12 million. In FY 2007, Nigeria was designated as a priority country for the Office of Population and Reproductive Health (PRH) and the budget was increased by $10 million raising the OYB level to a little over $20 million. The plus-up was guaranteed only for 2007, and any future increases are dependent on performance and potential for return on investments. Even at this level, the financial resources available through USAID are, at best, meager to address the problems of a neglected system expected to serve a large population. In order to be effective the team recommends that the Mission prioritize its actions and invest in those activities that will have maximum and lasting impact This report does not provide the answers but rather makes suggestions to be considered by the Mission as it moves to plan for its future investments. Key recommendations for the Mission and its partners include: (1) develop and have all partners adhere to a strategic vision that has clearly defined measures for outcomes and impact; (2) garner greater Nigerian ownership of USAID programs at the community, local government, state and national levels; (3) assist the GON and the private sector in defining a realistic package of essential MNCH and RH/FP health services that are realistic, effective, evidence-based and affordable, and that address the needs of the population in northern Nigeria; in planning, keep the client in mind and at the center of the program actions; (4) avoid stove piping of services and maximize integration where logical and mutually reinforcing for service acceptance, such as the integration of family planning into MNCH and HIV/AID services; (5) close the gap between the demand for services and the availability and accessibility of services; (6) continue to support service improvements and quality at both the public and private sectors, but given the potential of the private sector, consider alternatives for expanding quality services in the private sector; (7) further develop the systems and tools that improve the quality, effectiveness and efficiency of services and that underpin optimal service delivery functioning. Ensure that commodities and materials make it to the "last mile;" (8) leverage funding of other donors, foundations, the government, and the private sector to permit the replication of the models at least the state, and preferably at the national level; and (9) invest time and encourage better coordination between donors, and partners. A solid foundation has already been laid through the implementation of the current USAID Strategy. The task now is to plan for the future. The chapters of this document set the context for programming and give strategic, operational and management ideas for the Mission to consider as it moves to refine the current program and extend planning that is appropriate to the new innovations and the improving contextual environment. (Author abstract, modified)