Nigeria’s health sector stands on the verge of transformative change, driven by the recently launched Performance Management System (PMS) from the Federal Ministry of Health & Social Welfare. This initiative, led by the ministry, aims to improve the efficiency of health services, ultimately saving lives and enhancing the well-being of Nigerians.
The Coordinating Minister of Health & Social Welfare, Professor Muhammad Ali Pate, has emphasised the importance of PMS in line with the President’s Renewed Hope Agenda, marking a significant step towards the reform and optimisation of the health sector.
Key Areas for Performance Management System Implementation
The PMS is designed as a comprehensive tool to address several critical areas within the health sector:
Resource Allocation
PMS provides a structured framework for aligning human, material, and financial resources with strategic health goals. According to the National Health Accounts (NHA) report for 2018, Nigeria’s total health expenditure was estimated at ₦3.9 trillion (approximately $10.1 billion), about 3.6% of GDP. Effective resource allocation through PMS is essential to ensure investments are directed towards high-impact areas, such as maternal and child health, which continue to face significant challenges.
In 2021, Nigeria had an estimated 512 maternal deaths per 100,000 live births (NDHS, 2018), highlighting the urgent need to prioritise maternal healthcare.
Quality of Care
PMS systematically tracks performance metrics, identifying weaknesses in healthcare delivery and enabling targeted interventions. A 2018 WHO report revealed that only 39% of health facilities in Nigeria met minimum standards for quality care. By implementing performance metrics, PMS aims to improve this percentage through continuous monitoring and service delivery improvements, ultimately reducing morbidity and mortality rates.
Health Financing
The PMS addresses deficiencies in health financing by improving coordination between federal, state, and development partners. In 2021, the health budget was ₦500 billion (approximately $1.3 billion), representing just 5.7% of the national budget—far below the 15% target set by the Abuja Declaration in 2001. PMS can advocate for increased funding and ensure better utilisation of existing resources to address priority gaps effectively.
Governance and Accountability
The Permanent Secretary of the Federal Ministry, Daju Kachollom, has highlighted that PMS fosters transparency and accountability within health institutions. It ensures that all personnel are engaged in a collective mission to improve health services. With Nigeria ranking 150 out of 180 countries on the 2022 Corruption Perceptions Index, transparency and accountability are crucial in transforming the sector.
Performance Evaluation
PMS is more than an appraisal tool; it facilitates continuous performance evaluation and feedback. This ensures that health sector employees meet established goals and service standards. For instance, a 2019 study found that 60% of healthcare workers reported inadequate training for new health protocols, underlining the need for systematic evaluation and improvements.
Why PMS Matters
The implementation of PMS is essential for several reasons:
Improving Health Outcomes
Effective performance management directly correlates with better health outcomes. By focusing on performance metrics, healthcare providers can identify inefficiencies and enhance care quality. According to the 2018 Nigerian Demographic and Health Survey (NDHS), only 53% of births in Nigeria are attended by skilled health personnel. Through effective tracking and management, this statistic can be improved.
Enhancing Coordination
PMS ensures that various health entities work cohesively, addressing the fragmented nature of health services in Nigeria. A 2018 WHO report indicated that only 10% of health facilities are adequately equipped and staffed to provide comprehensive services, underscoring the need for coordinated efforts to strengthen healthcare delivery.
Strengthening Public Trust
By increasing transparency and accountability, PMS has the potential to enhance public trust in the health system. A 2021 Afrobarometer survey showed that only 36% of Nigerians trusted the government to provide health services, highlighting the need for improved governance that PMS can address.
Aligning with Global Standards
As health systems worldwide evolve, Nigeria’s implementation of PMS aligns with global best practices. Countries like Ghana and Senegal have adopted similar systems, leading to significant improvements in health service delivery. For example, Ghana’s Health Service Performance Assessment contributed to a 60% decrease in under-five mortality since 2003 (Ghana Health Service, 2021).
Comparative Success Stories: Africa and Beyond
Several countries have demonstrated the value of performance management in healthcare:
- South Africa has implemented a national health performance monitoring system, resulting in a decline in maternal and infant mortality rates. Maternal mortality dropped from 176 per 100,000 live births in 2014 to 138 in 2020.
- Kenya introduced performance-based financing in its health sector, leading to increased service delivery and higher patient satisfaction.
- Rwanda is often cited as a model for health sector management, using robust data collection and performance measurement to inform policy. This has led to significant improvements, including universal health coverage rising from 7% in 2003 to 85% in 2021 (World Bank, 2022).
- Singapore and Germany demonstrate how strong performance management frameworks contribute to efficient healthcare systems, resulting in lower costs and better health outcomes.
Who Will Benefit and Projected Impact
The PMS in Nigeria’s health sector is set to benefit multiple stakeholders:
- Patients and Communities: Improved health outcomes, enhanced care quality, and better access to healthcare services, with a focus on maternal and child health.
- Healthcare Workers: Performance evaluation and targeted training will improve skills and resources, enabling better service delivery.
- Health Institutions: Enhanced governance and accountability will create a more transparent and efficient system, fostering a culture of continuous improvement.
- Government and Policymakers: PMS will provide valuable data for decision-making, enabling better health policies and resource allocation.
- International Partners and Donors: Improved health financing and programme implementation will increase the effectiveness of funding from organisations such as WHO, UNICEF, and USAID.
Moving Forward
Nigeria’s commitment to the PMS, as articulated by Professor Pate and other officials, is commendable. This initiative has the potential to enhance health sector performance and create a more sustainable and equitable system for all Nigerians.
Collaborative efforts from stakeholders, including international partners, will be essential to achieving these goals. The recent ministerial leadership retreat in Bauchi State reflects this commitment, serving as a platform for dialogue and planning to realise a high-performing health sector.
The success of PMS will depend on data-driven decision-making, strategic partnerships, and strong political will. If implemented effectively, Nigeria’s health sector could see tangible improvements, fulfilling the vision of a healthier, more prosperous nation.
