PAS people’s scorecards on Kano, Kaduna, and Niger States indicated that lack of adequate accountability, non-transfer of staff to the states’ agencies, inadequate health workers, inadequate funds and non-release of take-off funds are mitigating factors affecting PHCUOR implementation in these states.

In Kaduna State, although the scorecard showed some improvements in strengthening the SPHCDA, establishing its Governing Board and management team needs to be expedited due to its role on other key domains. Implications and Recommendations are:

• A defined accountability and reporting line by the LGA Advisory Committee and LGHA Management Committee should be considered.
• The non-transfer of all staff providing PHC services to the SPHCDA and LGHAs could result in conflict between agencies and departments overseeing PHC services.
• The lack of health workers in line with the Minimum Standards for PHC in the facilities should be looked into and ways of bridging the gaps identified.
• The State did not release a take-off grant for the SPHCDA, demonstrating non-adherence to the prescribed funding structure for PHCUOR.
• Inadequate funds allocated to the SPHCDA and LGHAs suggest a need to advocate to the Kaduna State Government to improve funding allocations.
• Findings showed that Kaduna SPHCDA Management Team has no accountability platform to engage partners and other major stakeholders on PHCUOR implementation.
• Existence of a PHCUOR accountability platform that involves CSOs and meet regularly will ensure responsive, inclusive and participatory decision-making processes.

In Kano State, although the State has done well to inaugurate the governing board, but inclusion of CSOs representatives was not considered. Recommendations are:

• The state should implement the adopted and Costed MSP document.
• The LGHA team should be provided with copies of the PHCUOR Implementation Guidelines for effectiveness and alignment.
• The SPHCB Law that provides for the movement of PHC departments, PHC staff, programmes and funds in all LGAs in the State to the LGHAs should be adopted.
• Complete consolidation of all PHC functions under Kano SPHCMB including administering
  staff benefits should be prioritized.
• The skewed Human Resource for Health at all levels should be re-distributed.
• There is a need to ensure adequate documentation of Kano SPHCMB activities
• The State should adopt a costed Start-up plan for the take-off of the management team of LGHA.

In Niger State, findings showed that the SPHCDA bill was signed into law in December 2009, preceding the adoption of PHCUOR as a national policy for implementation in 2013. There is a urgent need to review and update the bill to capture all the key elements of the PHCUOR policy. Recommendations are:

• Review the MSP Document evaluating the resource gaps for implementation of the MSP.
• Reposition the SPHCDA with all the PHC department under one roof and transfer malaria, HIV/AIDS, TLM and NTDs to SPHCDA in order to comply with the PHCUOR policy.
• Carry out comprehensive review of the operational guidelines involving wider stakeholders that would detail HR, M&E, accounting and other procedures to be followed in the course of PHCUOR policy Implementation.
• SPHCDA should support the LGHA in developing costed annual operational and ISS plan and mobilize resources for its implementation.
• All the LGHAs should open a bank account, train team members on good financial management, and institute tracking and quality control mechanism to ensure transparency and accountability.
• SPHCDA should revise the criteria for the membership and composition of WHDC to capture at least 35% women representation in line with the PHCUOR operational guidelines.