Using performance-based grants to subnational governments to improve health outcomes: a repeated cross-sectional evaluation of the Saving One Million Lives Programme in Nigeria

Background: Performance-based grants (PBGs) to subnational governments have been used in other sectors to improve the delivery of government services, but have rarely been used in the health sector. This study aimed to assess changes in maternal, newborn and child health (MNCH) outcomes and quality of care associated with the implementation of PBGs under the Saving One Million Lives Programme for Results (SOML-PforR) in Nigeria. Methods: This study employed a repeated cross-sectional observational design. Trends in MNCH service coverage indicators and quality-of-care domains were analysed using nationally representative household and facility surveys conducted in 2016 (baseline) and 2021 (endline). Changes in incentivised and non-incentivised indicators across Nigeria's six geopolitical zones were used to assess coverage and equity. Coverage indicators were reported as percentages, while changes were presented as percentage points. Simple and multivariable linear regression analyses were performed to determine the effect of baseline coverage in 2016 on the percentage point change in coverage for MNCH indicators, with female literacy included as a covariate. Statistical significance was set at p