The Basic Health Care Provision Fund (BHCPF) in Nigeria faced significant challenges related to data management, reporting, and transparency across its healthcare gateways. These challenges hindered effective monitoring and evaluation (M&E) of healthcare activities, making it difficult to assess the impact of the BHCPF on healthcare delivery.
To design an effective solution, Sydani Group, in collaboration with the Bill and Melinda Gates Foundation (BMGF), recognized the need for a detailed landscape assessment to understand the current state of BHCPF implementation, the challenges faced by healthcare workers, and existing gaps in data collection and reporting.
Assessments/MEL/Data Management:
Sydani conducted a comprehensive landscape assessment across eight states in Nigeria, which included both rural and urban settings. The assessment aimed to gain deeper insights into the current situation of BHCPF implementation, focusing on:
• The skills and capabilities of healthcare workers involved in Monitoring and Evaluation (M&E).
• The systems and tools being used for data reporting and collection.
• Barriers and inefficiencies in data management, particularly at the state, LGA, and facility levels.
The assessment uncovered significant gaps in M&E capacity, especially in terms of M&E officers’ ability to use digital tools for data collection and reporting. Many facilities relied on manual or paper-based systems, which led to delays in reporting and inconsistencies in data quality.
Furthermore, it was found that a large portion of healthcare workers lacked the necessary skills to effectively use data management tools like Excel, ODK, and other M&E platforms.
In response to these findings, the project designed capacity-building modules to address the identified gaps. These modules focused on training healthcare workers in the use of digital tools for M&E, including a mobile application specifically developed for data collection.
Additionally, new tools and applications were designed to facilitate the reporting and analysis of healthcare data, ensuring a more streamlined and efficient process, enabling stakeholders to monitor BHCPF activities in real-time.
Result
The insights gained allowed Sydani to tailor capacity-building efforts to the specific needs of relevant stakeholders, resulting in significant improvements in their ability to collect, report, and analyze data. The mobile application developed for BHCPF data collection was successfully tested across over 7,000 facilities, and the real-time data visualization dashboard provided the National Primary Health Care Development Agency (NPHCDA) and other gateways with valuable insights. These tools have not only enhanced the transparency of BHCPF activities but also significantly improved the overall data reporting and collection process across multiple states. The integration with DHIS 2 and other existing platforms has optimized data analysis and reporting, providing valuable insights and learning for the NPHCDA, NHIA, and EMT gateways.
Capacity Building:
The capacity-building efforts were carried out in two phases:
1. Phase 1: Application Training
After the development of the mobile application designed to facilitate BHCPF data collection and reporting, training sessions were organized for stakeholders across the three gateways (NPHCDA, NHIA, and EMT). These sessions focused on building proficiency in using the app to monitor and evaluate BHCPF activities effectively, ensuring smooth adoption and integration into daily workflows.
2. Phase 2: Addressing Competency Gaps
Based on insights from the landscape assessment, additional capacity-building initiatives were designed to address the skills gaps identified. These gaps included limited proficiency in tools such as Microsoft Excel, Open Data Kit (ODK), and PowerPoint, as well as challenges with effective reporting. Customized training modules were developed and delivered to improve stakeholders’ competence in these areas, helping them enhance their day-to-day M&E activities and reporting capabilities.
Result:
The capacity-building initiatives received overwhelmingly positive feedback from participants. A post-training evaluation indicated that 100% of participants reported an improvement in their ability to use the tools and platforms introduced during the sessions. Additionally, many expressed a desire for further training, acknowledging that the sessions had significantly improved their competencies and would like to build on this momentum for continued development.
Research (Implementation & Operational):
The research focused on several key areas of the BHCPF implementation:
• Funding Mechanisms: The study assessed how facilities accessed BHCPF funds, including the steps required to apply for and receive the funds. It explored the sufficiency of the funds and how they were being used at the facility level.
• Efficiency of the Process: A detailed evaluation was conducted on the procedural inefficiencies surrounding fund disbursement. The research revealed that many facilities still relied heavily on paper-based processes for documenting and submitting funding applications, leading to delays in accessing the funds.
• Data Management Gaps: The research highlighted critical issues related to data flow. Despite receiving funds, facilities faced challenges in sending and receiving data, particularly when it came to reporting fund utilization. The use of manual, paper-based systems slowed down data processing and caused delays in documenting compliance with BHCPF requirements.
Based on these findings, the project team proposed the development of a digital solution—an app that would streamline the process by allowing facilities to submit documentation and reports digitally, reducing paperwork and expediting the receipt of funds.
Result:
The implementation research identified key inefficiencies in how BHCPF funds were managed and reported, particularly the reliance on manual documentation. These findings led to the recommendation and design of a digital solution to address these gaps. The proposed app aims to automate the reporting process, enabling facilities to submit their documentation electronically, thereby reducing delays in fund disbursement and improving data management.
By addressing these gaps, the research provided actionable insights that have the potential to improve the overall effectiveness and efficiency of the BHCPF program.
Product Design & Development:
Before the BHCPF MLE project, data collection and reporting for the Basic Health Care Provision Fund (BHCPF) were predominantly paper-based, leading to inefficiencies, inaccuracies, and delays. Facilities struggled with manual processes, which were not only time-consuming but also prone to errors, making it difficult to track fund disbursements, usage, and outcomes. The need for a streamlined, digital system to enhance monitoring and evaluation, as well as financial reporting, became evident as these issues hindered effective fund management and decision-making across the gateways (NPHCDA, NHIA, EMT).
In response to these challenges, the BHCPF MLE project designed and developed four key digital products aimed at improving the efficiency and accuracy of data collection and reporting:
1. M&E Tool (Mobile Application): This app was created to replace paper-based data collection, allowing users to easily gather and report Monitoring and Evaluation (M&E) data at facility, LGA, and state levels.
2. NHIA Website: Designed to support the National Health Insurance Authority (NHIA) in managing BHCPF data and improving the transparency of fund disbursement and usage.
3. MOOC Dashboard: A monitoring tool that provides real-time insights into the performance of the various BHCPF facilities and gateways, making it easier to track key indicators and outcomes.
4. NPHCDA Financial Tool: Developed with additional funding, this tool helps track the flow of BHCPF funds, providing detailed reporting on when funds were disbursed, how they were utilized, and the results achieved.
To date, two of the four products (the M&E Tool and the NPHCDA Financial Tool) have been successfully deployed. These applications were designed to help stakeholders transition from paper-based processes to a more efficient, automated system, ensuring better data quality and faster reporting.
Result:
The deployment of these digital products has had a significant positive impact. Facilities that have adopted the M&E Tool and NPHCDA Financial Tool reported a shift from manual to digital data collection, which has resulted in:
• Improved Data Quality: The tools enforce data validation rules that ensure accuracy, reducing the likelihood of errors commonly associated with paper-based data entry.
• Time and Cost Efficiency: Digital reporting has significantly reduced the time spent on data collection and reporting. Additionally, the transition away from paper has saved costs associated with printing and distribution.
• Faster Reporting: With real-time data collection via mobile devices, facilities can now submit reports more quickly, allowing for timelier decision-making and improved oversight.
However, the NHIA Website and MOOC Dashboard have not yet been deployed, which limits the ability to assess their impact. Nonetheless, the positive outcomes seen in the deployed products demonstrate the potential for these tools to further enhance the effectiveness of BHCPF monitoring and evaluation once fully operational.
