Performance Needs Assessment for Family Planning Program Recovery
From 1990 to 1998, when Nigeria was ruled by a military regime, the government’s spending on public health was curtailed severely. The budget for family planning and reproductive health (FP/RH) initiatives in the public sector plummeted to almost nothing, a fact reflected in discouraging birth rate, fertility rate, infant mortality and life expectancy statistics. In the aftermath of this crisis, USAID has undertaken a major expansion of FP/RH programs in Nigeria and asked a team of cooperating agencies headed by PRIME II to conduct a performance needs assessment of primary-level FP/RH delivery sites in December 2000. The study was carried out in three states: Oyo in the west, Enugu in the east and Bauchi in the north.
While the assessment uncovered regional differences, it also documented common threads. Throughout the country, a significant gap existed between the expectations of clients and communities and the actual delivery of services taking place at clinics. Important gaps were noted in the areas of client-provider interaction, infection prevention procedures, family planning counseling, record-keeping and the array of services offered. The study also found that providers lacked supportive supervision, clear job expectations including updated guidelines and protocols, performance feedback, and motivational recognition for work well done. While most providers had been trained in family planning and reproductive health practices, many of their skills needed to be upgraded. The assessment was instrumental in the design of USAID’s bilateral VISION project, which emphasizes the Performance Improvement (PI) approach for improving FP/RH services. In collaboration with VISION, PRIME strengthened Nigeria’s efforts to improve RH services by providing technical support in the implementation of a Maximizing Access and Quality (MAQ) Exchange in 2001.