In response to slow progress in improving health service delivery, the Government of Nigeria requested World Bank support in testing performance-based financing (PBF) and decentralized facility financing (DFF) as part of the Nigeria State Health Investment Project (NSHIP). PBF provides funding directly to health facilities based on the quantity and quality of services they deliver. Funds are transferred electronically to each facility’s bank account and they have substantial autonomy in how they use the funds. Up to half the funds can be used to pay performance bonuses to staff. Supervision was substantially strengthened. DFF was similar to PBF except that facility earnings were NOT based on the quantity and quality of services they delivered, they could not pay performance bonuses to health workers and the amount they received was, by design, half the amount earned by PBF facilities. Along with its attempts at improving service delivery through PBF and DFF, NSHIP also aims at strengthening institutional performance by using disbursement linked incentives (DLI) to the states and local governments on an annual basis. For example, local governments are rewarded for strengthening supervision of health facilities and publishing their annual budgets. States are rewarded for implementing PBF, and for increasing immunization coverage. States and LGAs are reimbursed for their eligible expenditure programs upon achievement of institutional performance outputs through the DLI approach.

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In a 2017 USAID report, it was noted that in Nigeria, in conjunction with the Federal MOH, FC+ is supporting a review of fistula strategy and its implementation. In addition, with the help of FC+, Nigeria published new guidelines for catheterization during prolonged labor and for “conservative treatment,” which involves catheterization for women with new fistula, within a period of up to six weeks postpartum. According to the same report, The Nigerian Federal health budget provides funding of fistula surgery at three federal fistula centers (Ebonyi, Bauchi, and Katsina) and state funds support fistula repair at state centers in Kebbi, Kano, Sokoto, Zamfara, Jigawa, Kwara, and Cross River. In Oyo State, the Ibadan University Hospital is responsible for most fistula surgeries in the state. FC+ was said to provide additional support with supplies and equipment.

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