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Nigeria is ranked 152nd out of 157th on the Human Capital Index (HCI), 154th on child survival index, and has the highest under-five child mortality rate (U5MR) among the lower-middle income countries (LMICs). With 714,000 Nigerian children U5 dying every year, the country is responsible for about 26% of all U5 deaths in sub-Saharan Africa and 13% globally. Hence, reducing U5 mortality in Nigeria is critical for human capital accumulation as well as improved overall health status in the country and in Sub-Saharan Africa.
Not only is Nigeria’s U5MR high, it is also very inequitable. Among children in the poorest income quintile, Nigeria’s U5MR is the highest in West Africa, twice the rate of Ghana or Senegal. Within Nigeria, children from the poorest quintile die at a rate that is 3.3 times higher than U5MR from the richest quintile. Both in relative and absolute terms, poor children in Nigeria are faring badly.

The selected firm is to work with the National PIU and State PIU team to conduct the following activities in the course of the assignment; The scope of services for the IVA includes the following: 1. Quality of Care: Every quarter, carry out ex-post verification of the quality of care and quality of supervision by LGA, SMEP staff in 10% random sample of public facilities under the NMEP gateway. This will use the standard quantitative supervisory quality checklist (QSQC) deployed by the NMEP/NPHCDA. This will involve: (a) identifying certified verifiers/Program officers with the requisite skills. (b) ensuring verifiers/Program officers are expert at the use of the QSQC. (c) ensuring the ex-post assessment is carried out within 2 weeks SMEP officials carry out their quarterly assessment. (d) Analyze the differences between the ex-post QSQC scores and the ex-ante scores and determine if there are substantial differences by facility, supervisor, and by indicator (by percentage point difference). (e) Provide the results of the analysis to the State Malaria Elimination Programme (SMEP), NMEP, the Secretariat of the National Steering Committee (TS-NSC) and the World Bank. 2. Quantity Verification: The IVA will employ the following approaches to quantity verification: (a) review of at least 10% of the data on all claims), at least on a quarterly basis to look for suspicious activities and outliers ((b) ex-post verification of the quantity of services on a quarterly basis using the community client satisfaction survey (CCSS) techniques employed under NSHIP and according to the PIM. This will involve taking a sample of 20% of contracted facilities, visiting the facilities to take a sample of 60 patients. Facilities with suspicious claims (from the claims review) will be given priority during facility sample selection. The sampled patients will be either telephoned not more than 40% or visited in their homes to determine whether: (i) the patients exist; (pregnant women and children under 5 years) (ii) they visited the health facility during the period under review and received the services listed. (iii) they were satisfied with the care; and (iv) did not have to pay for any services deemed to be free. The sample selection will use a mix of random and risk-based approaches. 3. Process Verification: The IVA will take advantage of visits for quality and quantity verification to assess whether the processes in the PIM are actually being implemented. This will include: (i) whether Long-Lasting Insecticide-treated Nets (LLINs), Artemisinin Combination Therapy (ACTs), Rapid Diagnositic Tests (RDTs), Sulphadoxine-Pyrimethamin (SP), etc for routine distribution have been received at the health facility and are being distributed based on national guidelines. (ii) if Quality of Care (QOC), Data Quality Assessment (DQA) are being implemented based on national guidelines. (iii) whether other contractual obligations of NGOs at facilities level (such as capacity building in Case Management and Diagnosis, LMIS, HMIS) are being adhered to. 4. Reporting: The IVA will carry out the data collection, analysis, and report writing in response to the above scope of work. The IVA will be responsible for transparently disseminating the reports widely to various stakeholders. The reports will: (a) Analyze the differences between the ex-post quantity verification and the claims submitted by the NGOs. The IVA will determine if there are substantial differences by facility, LGA, and by indicator. (b) determine if there are/ have been additional user-charges levied on patients; (c) suggest sanctions in keeping with the PIM; etc. 5. The Independent Verification Agent will conduct verification for each NGO using the results of the key surveys (LQAS, SMART and NHFS) and use the agreed algorithm to compute performance of each NGO. The IVA will be responsible for forwarding the results of each NGO’s performance to the NMEP who make the results available to each individual state. 6. Carry out such tasks as the NSC reasonably requests to facilitate the successful implementation in the participating states.

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