# 8.3 The state of the states

As part of this review, visits were made to six states, covering three regional zones, three of which received the TA from ADG and three of which did not. In each of the states we made a rough assessment of the political context, progress in implementation and fund utilization, problem identification, range of solutions arrived at and success in improving outcomes. Our findings are briefly summarized in Table 3.

## **TABLE 3: HIGHLIGHTED CHARACTERISTICS OF THE SIX VISITED STATES**

|**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)**|
|---|---|---|---|---|---|---|
||<br> <br> <br>|<br> <br> <br>|**_TA states_**<br>||<br> <br>||
|Kogi|One<br>of<br>the<br>stronger<br>states.<br>Advanced<br>in<br>implementation<br>with<br>strong<br>evidence<br>of<br>innovation,<br>adaptation<br>and impact. Benefitting<br>from<br>a<br>somewhat<br>supportive context, and<br>actively engaging with<br>political<br>realities<br>for<br>greater effect.|Kogi<br>has<br>had<br>a<br>**somewhat**<br>**supportive political environment.**<br>Governor was up for re‐election<br>and has been eager to demonstrate<br>gains in health service delivery<br>since this was a key campaign<br>promise. This has not translated<br>into regularized payment of health<br>worker salaries however and salary<br>arrears were running at 5 months<br>during our visit. Commissioner<br>highly supportive and well‐versed<br>in SOML objectives. There were<br>some issues that the team describe<br>as “internal competitive rivalry”<br>rather than political interference,<br>with certain figures wanting to<br>chair committees or be part of the<br>PMU – ADG helped manage these.|**Sustained implementation since**<br>**March**<br>**2017.**<br>Began<br>implementation of workplan in<br>March 2017.<br>A good number of interventions<br>well underway, including drug<br>procurements and distributions,<br>various trainings, sensitizations,<br>advocacy<br>campaigns<br>and<br>supervision visits.|**Wide range of solutions from**<br>**the typical (QISS and MNCH**<br>**weeks) to the innovative.**E.g.,<br>introduction of food incentives –<br>“pluses” – to improve levels of<br>trust and usage of PHCs; use of<br>private clinics as distribution<br>points for Vit A; engagement of<br>community volunteers selected<br>_by the community,_thereby<br>allowing<br>greater<br>access<br>to<br>people’s houses for purposes of<br>giving advice and monitoring<br>utilization; resurrection of ward<br>management committees.<br>Also evidence of engagement<br>with<br>political<br>realities<br>e.g.<br>coordinating net distributions<br>with Governor campaign in order<br>to<br>increase<br>resources<br>and<br>impact.|Engagement<br>of<br>locally<br>selected<br>community<br>volunteers appears to have<br>increased bed‐net utilization<br>as well as awareness of PHC<br>services and greater use of<br>PHC facilities.<br>Reinvigoration<br>of<br>ward<br>committees appears to have<br>had<br>direct<br>impact<br>on<br>community ownership and led<br>to<br>infrastructure<br>improvements being financed<br>by community members.<br>MNCH weeks have positively<br>impacted<br>Vit<br>A<br>and<br>immunization rates.|**Improved.**One of only 2<br>TA states that improved<br>performance against its<br>baseline according to the<br>MICS<br>2016<br>survey.<br>Though PMU confirms<br>these<br>improvements<br>happened before any<br>SOML<br>implementation<br>was underway.<br>Although Kogi improved<br>in 3 of the 5 indicators<br>measured by MICS and<br>had a sum increase of<br>12.9% overall, it had<br>regressions of ‐33% and ‐<br>3.7% in Penta 3 and in<br>CPR respectively.|

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