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Table 1 Brief description of the PHCUOR framework and Fidelity Assessment Criteria

From: Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria

Domain Brief Description Fidelity Assessment Criteria
1. Governance and Ownership State governments are required to appoint governing bodies and establish organizational leadership structure for the SPHCDAs. The governing body is crucial for setting the PHC vision, winning resources, and holding implementers to account. Available organogram, appointed chief executive with management team distinct from governing board, accountability mechanism evidenced by periodic report and established reporting lines through the commissioner for health
2. Legislation The Policy requires that state governments enact laws and regulations for the establishment and functioning of the SPHCDAs. Legislation provides the legal framework while regulations are more specific, containing the enabling language and details of actions needed. Gazetted law in place having undergone stakeholder consultation, passage by legislature and assent by the governor
3. Minimum Service Package (MSP) The MSP allows states to classify their facilities according to the adopted system and then determine resource needs for each facility. This approach provides evidence for effective, equitable planning and resource allocation for health Costed MSP developed, adopted and funded. Health facilities classified and service delivery planning and funding done using the costed MSP
4. Repositioning Managing organizational change, re-orientation, capacity building and mentoring of managers in the new and old structures to align with new roles and responsibilities Agency law transfers all PHC structures and functions to the SPHCDA. Stakeholders engaged to create awareness and buy-in to the implications of reforms. Re-orientation plan for staff available and being implemented
5. Systems Development Establishing state & sub-state structures with one management, one plan, one M&E system; ensuring an appropriate governing board oversees the management team SPHCDA strategic plan available. Operational plans for state and LGAs available. Financial management policy in place. Guidelines and procedures for recruitment of staff into state and sub-state level structures available. Integrated Supportive Supervision plans implemented quarterly as planned. Clinical guidelines for various interventions available at service delivery level
6. Operational Guidelines Developing policies, procedures and regulations for HR, procurement/supply chain, accounting/financial management and monitoring & evaluation aligned with national and state policies PHCUOR implementation guidelines and regulations adapted and operational
7. Human Resources Effective system for managing human resource issues such as appointment of management staff at state and sub-state levels, addressing mal-distribution of staff, ghost workers and cadre imbalance and plans to train, attract, incentivise and retain staff in unattractive postings. Committee to implement transfer of all PHC human resources from parallel structures to the Agency established and transfer completed. Human resource audit conducted and operational Human Resource Information System available. Job descriptions available for facility managers and all health workers. Costed Human Resource capacity building plan available. Clear staff recruitment procedures available for all levels of governance
8. Funding Sources and Structure Developing financial management systems, budget processes, audits, pooled funding and take off-grant Dedicated budgeting and fund release system for the Agency operational. Integrated PHC (basket) funding system operational. LGA financial contributions deducted at source. Payment of salaries of all health workers at service delivery level, as well as benefits and pensions, fully the responsibility of SPHCDA.
9. Office Establishment Provision for physical structures, infrastructure and equipment to enable the SPHCDA function Agency offices established at state and sub-state levels
  1. Sources: [13, 18]