|**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)**|
|---|---|---|---|---|---|---|
|Rivers|Implementation has been<br>slow to start but now<br>moving.<br>Standard<br>interventions<br>for<br>the<br>most part, with some<br>isolated<br>examples<br>of<br>innovation<br>and<br>little<br>evidence of impact as of<br>yet. Strong indications<br>that any improvements<br>on SOML indicators thus<br>far have been down to a<br>particularly<br>conducive<br>political environment.|**Highly supportive political context.**<br>Health worker unions are powerful<br>in Rivers and prior to the initiation<br>of SOML there was a health worker<br>strike that lasted one year. The<br>current Governor – nicknamed “Mr<br>Projects” – came to power on the<br>back of a campaign to deliver major<br>improvements in the health sector<br>and<br>address<br>health<br>worker<br>remuneration.<br>Considerable<br>amounts have since been spent<br>from the state budget raising and<br>harmonizing salaries, building and<br>upgrading health facilities (e.g. 14<br>secondary<br>health<br>facilities<br>completely<br>renovated),<br>and<br>harmonizing<br>administrative<br>structures. The Commissioner for<br>Health refers to the Governor as<br>“The friend of the health sector”<br>and narrates how health receives<br>the second highest expenditure in<br>the state (after works).<br>Rivers is the only state in our<br>sample where PHCUOR has been<br>implemented and the responsibility<br>for PHCs now lies with the State<br>Primary health care facility rather<br>than Local Governments. Salaries<br>are reportedlyallpaid on time.|**Implementation slow to start**<br>**but**<br>**now**<br>**moving**<br>**fairly**<br>**smoothly.**Despite money having<br>arrived earlier in Rivers than the<br>other states (around January<br>2017), there was a major delay in<br>accessing funds due to incorrect<br>designation of the account as a<br>naira rather than dollar account.<br>Implementation<br>eventually<br>began in June 2017. By August<br>2017 an MNCH week had been<br>run, with a positive impact on<br>the data. Another round has<br>been run in January 2018.<br>Evidence<br>of<br>trainings,<br>procurement of drugs, nets and<br>equipment<br>ongoing.<br>Some<br>standard interventions – like<br>QISS – still have not been<br>initiated.<br>TCG<br>not<br>meeting<br>regularly due to limited funds.<br>And orientations on SOML still in<br>process despite 2 years into<br>program.<br>Complaints that procurement<br>and approval processes lead to<br>long delays in interventions.<br>Little<br>evidence<br>of<br>adapting<br>workplans.|**Most solutions follow typical**<br>**model but some evidence of**<br>**innovation.**The majority of<br>solutions seem focused on re‐<br>trainings, procurement of drugs<br>and equipment, immunization<br>campaigns etc. But also some<br>interesting attempts to shift<br>behavior in rural communities<br>e.g. one intervention involves<br>the<br>training<br>of<br>community<br>members who have used SBAs or<br>CPR as “interpersonal change<br>agents” on the basis that<br>individuals are more likely to<br>listen to their peers than an<br>outsider. Also experiments with<br>results‐based payments e.g. the<br>retired health workers receive<br>incentives if they succeed in<br>bringing 20 women for ANC.|The one area where the team<br>is confident that they have had<br>an impact so far is with MNCH<br>weeks.<br>With<br>the<br>other<br>interventions there does not<br>appear to be any certainty/<br>evidence as yet of a positive<br>impact.|Rivers<br>had<br>a<br>21.5%<br>improvement<br>on<br>its<br>baseline according to the<br>2016 MICS survey. We<br>are not privy to the<br>breakdown.<br>Given<br>that<br>no<br>implementation<br>had<br>begun by the time these<br>results came in, they<br>seem to be testament to<br>the impact of the broader<br>context, specifically the<br>Governor’s<br>efforts<br>to<br>address health worker<br>performance<br>and<br>improve<br>health<br>infrastructure.|

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