Nigeria’s Saving One Million Lives Initiative: A case study of country leadership to achieve results
The Saving One Million Lives (SOML) Initiative was launched in Nigeria by the President in October 2012, focusing on results and outcomes across six priority ‘pillars’: 1) strengthening RMNCH delivery platforms, 2) routine immunization coverage and polio eradication, 3) mother to child transmission of HIV, 4) access to essential RMNCH commodities, 5) malaria control and 6) child nutrition. In its original incarnation, SOML had a deadline of 2015 to match the MDGs as well as the 2015 presidential elections. The Federal government extended the initiative in 2015 with new World Bank funding for a linked four-year performance-based Programme for Results (P4R). Going forward, states will receive additional resources through P4R based on their performance on five process and outcome-related indicators.
SOML became a national priority initiative in Nigeria under the leadership of the Minister of State for Health. It has focused national attention on the basics of a primary health care approach, articulated strategic priorities for the Federal government and the health sector, and re-oriented service delivery discussions to results rather than inputs.
Further, the SOML team at the Federal level emphasized frequent and robust monitoring. Ongoing programme success was tracked using service coverage rates and related estimates of changes in mortality. A national scorecard was developed to compare states and encourage improvements. The Nutrition and Health Survey (NHS), which originally focused solely on northern Nigeria, was expanded to cover the entire country, explore additional RMNCH-related services and produce state-level data on an annual basis. This survey is now the main source of data for the new P4R to determine state financial incentives.
The Federal government also undertook specific actions to coordinate existing programmes to achieve better results. This national level coordination encouraged various state-level actors across HIV and maternal care programmes to use resources more effectively to make progress in PMTCT. The SOML team also worked to bolster accountability of managers and health workers through engagement, encouragement and incentives. In addition, the Federal SOML office put together coalitions of private sector companies and philanthropies to support the initiative. Compared to the usual focus on public services only, this emphasis on partnerships was an innovation to accelerate progress towards results. The Ministry of Health also tapped into special Federal accounts with resources to fund and manage large scale programmes outside of the regular Ministry of Health budget.
Programme areas that the country leadership prioritized and that have shown promising results include polio eradication, malaria control, routine immunization (particularly in northern Nigeria) and community management of acute malnutrition.