|**State**|**Summary**|**Political support / interference**|**Status of interventions and fund**<br>**utilization**|**Range of solutions**|**Examples of problems fixed**|**Performance on the six**<br>**key indicators (2016)**|
|---|---|---|---|---|---|---|
|Akwa Ibom|Powerful<br>commissioner<br>creating a very supportive<br>context<br>for<br>improvements<br>in<br>the<br>sector.<br>Implementation<br>well<br>underway<br>but<br>expenditure<br>seems<br>mainly to be contributing<br>to sector‐wide objectives<br>rather than specific SOML<br>objectives. Issues of weak<br>problem diagnosis, data<br>analysis and an over‐<br>reliance on implementing<br>partners. Low levels of<br>understanding regarding<br>the PfR instrument and its<br>implications<br>for<br>procurement, contracting<br>etc.|**Somewhat**<br>**supportive**<br>**political**<br>**context**<br>**but**<br>**bureaucratic**<br>**obstacles.**The Governor in Enugu is<br>reportedly committed to improving<br>health service delivery. He has<br>appointed a Commissioner for<br>health who was former Chief<br>Medical Officer of a major private<br>company – Exxon Mobil – and has<br>been given space and resources to<br>rejuvenate the health sector. The<br>Commissioner appears supportive<br>and committed to SOML objectives.<br>The fact that PHCs still fall under<br>the remit of Local Government<br>(PHCUOR<br>having<br>not<br>been<br>completed), but the commissioner<br>has proven powerful/ respected<br>enough to enforce a level of<br>discipline<br>(he<br>regularly<br>visits<br>facilities unannounced, has fired<br>doctors, initiated prosecutions for<br>fraud and reward programs, etc.)<br>and has succeeded in completely<br>clearing a backlog of salary arrears.<br>So, despite PHCUOR not yet being<br>fully implemented, motivation and<br>performance of health workers are<br>said to have improved significantly.|**Above**<br>**average**<br>**expenditure**<br>**with an emphasis on equipment**<br>**and infrastructure.**60% of SOML<br>funds<br>utilized<br>thus<br>far.<br>A<br>significant<br>amount<br>of<br>expenditure is being allocated to<br>inputs that are not directly<br>related to SOML goals e.g.<br>Essential<br>drugs,<br>generators,<br>refrigerators,<br>HIV<br>test<br>kits,<br>Infrastructure.<br>A number of standard SOML<br>interventions have not been able<br>to run, apparently due to “lack of<br>funds”.<br>MNCH<br>weeks<br>for<br>example did not run in 2016 and<br>have not yet run in 2018. Highly<br>reliant<br>on<br>implementing<br>partners<br>e.g.<br>UNICEF<br>for<br>supplying vitamin A.<br>We noted pronounced confusion<br>about the nature of the PfR, with<br>members of the PMU very<br>unclear<br>about<br>procurement<br>requirements.|**Evidence of some innovative**<br>**solutions, but many solutions**<br>**that do not seem clearly linked**<br>**to the problem or goal.**One<br>innovative solution is the piloting<br>of “husband schools”: in an<br>effort to target men, who have<br>significant<br>decision‐making<br>power in the household, short<br>term ‘schools’ are set up in a<br>community that men are invited<br>to attend, for instruction on<br>immunizations, contraceptives,<br>skilled birth attendance etc.<br>But it seems that high levels of<br>expenditure on infrastructural<br>needs and large equipment<br>purchases (neither of which link<br>specifically to SOML goals) have<br>squeezed<br>out<br>other<br>interventions.<br>The<br>team<br>consistently reflected on a lack<br>of funds and a reliance on<br>implementing<br>partners.<br>And<br>other solutions, such as training<br>of TBAs and procurement of nets<br>do not appear to be being done<br>with deep thought regarding the<br>foundational problem and its<br>drivers.|The one example that the<br>PMU<br>could<br>give<br>of<br>an<br>intervention having impact<br>was the ‘husband schools’.<br>Apparently<br>DHIS<br>data<br>demonstrate improvements in<br>CPR and in SBA in the areas<br>where the schools have been<br>piloted.<br>As with other states, they<br>appear generally unaware of<br>the impact of other inputs.<br>Data are incomplete and not<br>considered reliable.|Akwa Ibom had a sum<br>total of 24% reduction<br>from<br>its<br>baseline<br>according to the 2016<br>MICS survey. We are not<br>privy to the breakdown.|

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