Implementation of a Systematic Accountability Framework in 2014 to Improve the Performance of the Nigerian Polio Program

In 2014, the World Health Organization (WHO) declared that polio is a public health emergency of international concern, as defined by the WHO's international health regulations [2]. Accordingly in addition to the four proven strategies namely strong routine immunization, supplemental immunization activity, mop up activities and strong surveillance other new strategies and the implementation of accountability mechanism are crucial [1, 2]. The WHO follows a results-based management approach that calls for delegated responsibility, authority, and accountability in a decentralized environment at all levels of the organization. This means that decisions on the use of financial and other resources are taken by managers at all levels in all locations. Therefore, accountability is at the core of performance evaluation. In addition, tracking health progress at the global and country level through adequate and quality data has been given attention at all levels to foster accountability [3, 4]. In addition to these guiding principles and policies, studies were conducted to determine the link between accountability principles and the results of their implementation. Work by Cleary et al suggests that, while resources and capacity are necessary conditions of functionality, the link between organizational culture, relationships, and accountability processes is a key consideration in any intervention and context [5]. One focus of accountability is improving program performance through close monitoring of selected priority activities. Research conducted in Tanzania showed that among other things setting priorities requires accountability and transparency in the system [6, 7]. Accountability should also focus on managing human resources. A study of the impact of targeted programs on health systems, using polio as a case study, revealed a global gap in the documentation of the basic approaches in managing human resources [8]. Another arm of accountability addresses how financial resources are managed and used for program performance. A report on the financial resource requirement for the global polio eradication initiative 2013–2018 stated that $250 million per year will be required by Nigeria for successful completion of the milestones in the polio endgame strategy. This huge resource requirement has put a responsibility on donor recipients to demonstrate results for the investment in the program. A review of the transparency and accountability initiative by Mulley on donor aid identified that the overall principle that governs donor aid is transparency and accountability for commitments and results [9, 10]. Many studies have been conducted to determine the reasons for the challenges associated with polio eradication in Nigeria. Tagbo cited a poor accountability framework as one of the major challenges in achieving polio eradication in Nigeria [11]. The Independent Monitoring Board of the Global Polio Eradication Initiative, in October 2014, and the 27th Expert Review Committee on Polio Eradication and Routine Immunization in Nigeria reports and recommendations also elaborated the need for systematic accountability in Nigeria, in which people are held responsible for delivering results [12, 13]. The 2014 Nigeria National Polio Emergency Plan emphasized strict accountability at all levels as one of the strategic priorities. The WHO, as the technical organization and implementing partner, is responsible for monitoring activities, through systematic implementation of an accountability framework, this is due to emphasis in the emergency plan of action for Polio for the country [14]. As one of the major stakeholders in the polio eradication initiative in Nigeria, the WHO country office manages >2500 staff throughout the country for polio and other health programs. But how do these personnel function in improving program performance, and how does the implementation of systematic accountability contribute to improved individual staff performance? We set out to determine the influence of systematic accountability framework implementation on the performance of WHO-Nigeria staff and the polio program.