Improving facility-level performance in primary healthcare system through strengthening management and financial resource utilization in Kano State, Nigeria

Nigeria's Minimum Service Package (MSP) standards were developed to bolster Primary Health Care (PHC) and Universal Health Coverage. This study assesses the impact of an intervention to get PHC facilities in Kano State meet the MSP standard through enhancing efficient utilization of the Basic Health Care Provision Fund, and strengthening the availability, access, and utilization of minimum PHC services. This was a longitudinal study involving 49 PHC facilities in Kano State. The Clinton Health Access Initiative provided technical assistance to train facility managers on facility management and supported the deployment of a multidisciplinary team to guide facilities in identifying and addressing facility readiness bottlenecks. The facilities received continuous mentoring support for two years, thereafter, they were reassessed. Facilities providing 24-hour services increased significantly ( p < 0.001) from 53.1 % (n = 26) to 79.6 % (n = 39). Skilled healthcare workers increased significantly (p < 0.001) from X ¯ = 11.14 to X ¯ = 20.80. The availability of functional tracer equipment significantly improved (p = 0.004), but that of tracer drugs was not significant (p = 0.538). The tier-one services provided increased from 84 % to 91 % (p < 0.001). Monthly antenatal care attendance increased significantly (p < 0.001), but quality of care indicators such as the use of partographs did not show a significant increase from baseline (p = 0.286). The interventions towards meeting MSP standards significantly improved infrastructure, staffing, and service availability using existing resources, although quality of care indicators showed limited change in the focal facilities. The findings suggest a promising strategy for the Nigeria's health sector renewal initiative, showcasing the potential to improve resource utilization and health outcomes.