have little sense of any impact yet. When asked about whether they’d improved on any indicators, they indicated that it is too early to tell. Moreover, we saw less sign of the team making decisions based on evidence or a detailed understanding of the problem. Members of the old PMU claim that tasks have deviated significantly from the previous workplan (for example the QISS component was removed on the basis that it was too expensive, though it has since been reinstated) and that the emphasis has been on large procurements that they believe will have little bearing on the indicators. We were told that four vehicles have been procured at inflated costs for example, two of which are being used by individuals and not for the program at all. We also noted that some procurements the team discussed with us are actually related to the advancement of general health objectives (for example procuring generators) and do not seem to have been made with a clear attention to their impact on the six indicators.

We found that the current PMU does have technically capable people in it, some of whom benefitted from the ADG TA. We also found that their discussion of future interventions showed some appetite for innovation and some attention to outcomes, though this was not so pronounced as their Kogi and Anambra counterparts. Current interventions, such as the installment of a data monitoring chart in all the health facilities, show some promise and an appetite for innovation, but in general, we noted that most of their interventions are still in planning phase, with very little actually delivered. Given that the budget is supposedly over 80% spent, this suggests that a large part of expenditure may have been diverted to inputs that were not directly relevant to SOML.

Unlike the other states, Abia was unable to present us with any current DHIS data on their performance against the six indicators. We also noted that the new PS is fairly unaware of SOML and, unlike his Abia and Anambra counterparts, did not seem to know the various indicators.

# 8.2 Factors that contribute to divergence in outcome indicators between states

|**Existing levels of state**<br>**funding**|The 36 Nigerian states have very different levels of existing revenue available to them and<br>therefore different levels of additional resource to draw on in order to supplement SOML<br>funds. It is apparent that whilst the delay in SOML funds arriving in some states meant<br>those states were unable to begin any substantial interventions, there are other, more<br>financially viable states who were able to continue complementary activities even in the<br>absence of fresh resources. A state like Rivers which has a higher Internally Generated<br>Revenue (IGR) and receives a greater federal allocation than any other state, has drawn on<br>a large bank of resources to supplement SOML efforts, building health infrastructure,<br>improving health worker remuneration and heavily investing in equipment at health<br>facilities. The simple fact of state indebtedness is likely to have a major impact on health<br>interventions since it directly impacts health worker salaries and therefore motivation.|
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|**Presence and capability of**<br>**the private sector**|As indicated, the ADG states were selected from a group of 16 states that began with a<br>higher baseline on the six coverage indicators; apparently this was considered a rough<br>proxy for existing levels of “capability”. These states were judged to be higher in existing<br>capability and lower in existing donor activity. But this is a crude measure of capability. It<br>has since been pointed out that higher‐than‐average baselines probably reflected the<br>capability of the private more than the public sector in many of these states (interview,<br>WB). In practice, there is likely to be wide divergence between capability of the public<br>sector across the states and there is little hard evidence to support the assertion that the<br>pool from which ADG states were selected have a higher capability to start with. And<br>assuming that the private sector_is_a major driver of improved coverage, then the extent<br>to which the private sector is supported, enabled and capable (a fact which is largely<br>beyond the scope of SOML) becomes a major factor in the ability of states to improve the<br>six indicators.|

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