The Primary Health Care Systems Development (PHCSD) Department has the responsibilities of making basic health services available and accessible to Nigerians, ensuring that the health facilities and services are within reach, that Nigerians are financially protected against ill health, building the capacity of its human resource and providing essential logistics support for the implementation of primary health care at the Ward level.

The PHCSD department has championed ACCESS to health services at the PHC level with the construction of Model Health Centres nationwide with a complement of trained staff providing essential health care. In collaboration with the States, a total of 1000 primary health care facilities in the rural communities are engaged with 4000 Midwives under the Midwives Service Scheme(MSS).
These midwives have been trained on Life Saving Skills(LSS) and the Integrated Management of Childhood Illnesses(IMCI) and empowered with midwifery kits, basic equipment, drugs, Mama Kits and family planning consumables to provide quality maternal and child health(MCH) services at the ward level. Health Management Information System (HMIS) forms are available to capture data generated from health service delivery which acts as tools for reappraisal of programs and planning.

Participatory Learning and Action (PLA) activities have been used as a tool to improve access through the formation of Ward Development Communities (WDCs) which assist in breaking down negative socio-cultural barriers and so drive the communities to demand for health care services. Health manpower development is strategic in the activities of the department building the capacities of manpower at the State and the Local government levels through organised trainings.
In all its activities the department has collaborated with various development patners and organisations. The PHCSD department has three divisions which are as listed below:

1) Health Financing and Health Economics
2) PHC Capacity Building
3) Essential Systems Support/Development

A major programme of the department has been the establishment of the Midwives Service Scheme (MSS) by the Federal Government of Nigeria under the 2009 Appropriation Act as a response to the high Maternal, Newborn and Child mortality figures. These high rates have been attributed to the dearth of skilled attendants at birth.
The Scheme has mobilised basic, unemployed, retired midwives and Community health workers for deployment to selected primary health care facilities in rural communities nationwide. The program is based on a Cluster model of four(4) primary health centres linked to a Referral General hospital.

Each MSS designated health facility has a complement of four midwives to ensure 24hr coverage. In the North East and North West zones where the maternal mortality rates are highest, female community health workers have been deployed to assist the midwives.

The Department has numerous publications on the Midwives Service Scheme. Some of these are listed below:





The World Bank and the National Primary Health Care Development Agency (NPHCDA) on behalf of the Federal Government of Nigeria is in the process of piloting results based financing (RBF) pilot project, in the states of Adamawa, Nasarawa and Ondo under the Nigeria State Health Investment Project (NSHIP).

The RBF project provides incentives for improving performance at critical levels within the Nigerian health system and aims to address some of the observed challenges.

A key feature of the RBF project in the Nigerian context is performance –based financing (PBF) where health facilities receive financial incentives based on the quantity and quality of services they deliver. Under the scheme, health facilities have autonomy to utilize the received finance for improvement of their health services and also pay for incentives to individual health workers.

Findings from the pre-pilot of the PBF initiative have shown significant achievements in overcoming supply-side challenges in health service delivery and increases in service utilization.

However, service utilization remains low in absolute terms and might be further improved by identifying and addressing additional challenges on the demand side. Moreover, there is a large variation in the service utilization among health facilities, part of which can be attributed to different demand conditions.

The primary objective of this formative research is to understand why communities are not using health care services in the facilities that are implementing the performance based financing (PBF) program in order to design a demand side intervention to complement existing supply-side interventions.