Partnership for Reviving Routine Immunization in Northern Nigeria;
Maternal Newborn and Child Health Initiative

> Lessons learned > Achievements

Achievements





2011 Achievements

Key achievements of PRRINN-MNCH during 2011 include the following (2011 Annual Report to follow):


Key Results

Looking at 2011, some of the key highlights include:

  • The midterm household survey showed a significant improvement in the clusters the PRRINN-MNCH programme has been active in. The standout result is a significant decline in Infant Mortality Rate (IMR), which was halved, backed up by changes in output and outcome indicators of coverage and utilisation. Full details are available here .

To illustrate the impact of this decline in IMR, as measured by the midterm household survey, a crude calculation of infant lives saved if the PRRINN-MNCH programme covered all the clusters in the state would see a decline from 62,000 infant deaths to 33,000 infant deaths per annum.

 

  • These changes were supported by the results from the 2011 KAP survey. The results indicated significant changes in knowledge, attitude and practice with respect to MCH. Full details are available here .
  • Data from the routine HMIS system and the programme M&E system further illustrate these changes. Increasing access, utilisation and coverage of services seem to be the basis for these changes. Full details are available here  and here.

These figures are calculated using the IMR decline and applying it to the under one populations in the four states in 2009 and 2011 respectively. It is crude as there is no attempt to apply it only to the clusters PRRINN-MNCH is active in. However, it does illustrate the potential savings if the programme was operational across the whole state which it is projected to do by 2013 in Yobe and Zamfara and half of Katsina state.

Governance

 

  • All states have adopted the national Strategic Health Development Planning M&E framework to track state health plan implementation. The 2012 planning and budgeting process was more participatory and led by state and LGA teams with limited technical and financial support from the program.
  • Expenditure and health performance reviews were conducted in all cluster one LGAs and at state level .
  • The PHCUOR concept note, policy brief, and implementation guide was approved at the 54th session of the National Council for Health. 
  • PHC or Gunduma Boards continue to be strengthened in Jigawa, Yobe and Zamfara.
  • Draft Minimum Service Package and Service Delivery Planning costing templates were developed.
  • The Basket Fund in Zamfara continues to attract attention.

More details on lessons learnt on health sector reform are available here.

Improved human resource policies and practices for PHC

 

  • All states, at a minimum, have draft HR policies and plans (that include a gender component).  
  • 69% of professional staff in targeted PHC facilities were given in-service training in MNCH (Zamfara 100%); 76% of targeted facilities have at least one health worker trained in LSS (Zamfara 100%)
  • All state HR coordinating committees meet regularly on a quarterly basis and are utilising Human Resource Information System (HRIS) reports.
  • The capacity of the HR units in all states was improved through additional training of staff on HRIS, management tool kits, and Training Information Management System (TIMS).
  • Development of costed accreditation plans for the 11 training institutions (schools of nursing and midwifery plus schools of health technology) of the 4 states.

Improved delivery of MNCH services via the PHC system 

  • Technical support continued to be provided to the NPHCDA in support of the MSS
  • Technical assistance and quality assurance support provided to states for step down competency-based Life Saving Skills (LSS), EOC and Neonatal Care (NC) skills training.
  • Training provided for QI, Maternal Death Review and Perinatal Death Review. 
  • Review of Kangaroo Mother Care (KMC) implementation has provided lessons and a way forward to the strengthening of current implementation processes and scaling up of KMC.
  • Technical support provided for the review of Community Based Service Delivery (CBSD) pilot project, which revealed that it is a promising strategy for extending access to essential services.
  • Strengthening of the routine immunisation system is ongoing.
  • Revised PPRHAA (Peer and Participatory Rapid Health Appraisal for Action) guide and tools finalised, circulated and used for the 2011 PPRHAA exercise across the states
  • Final versions of the following documents produced and circulated to all states: a) A Guideline on Facility Rehabilitation and b) Standards and Specifications for Buildings providing EOC services
  • SDSS (Sustainable Drug Supply System) fully established in cluster 2 facilities in Yobe and Zamfara States and states beginning to take more ownership in monitoring of services

Operational research evidence

  • MTR MNCH survey concluded; two HDSS update rounds completed.  
  • Second round state OR protocol development meetings in all states completed. 
  • Qualitative rapid assessments of state specific incentive bundles to attract, recruit, and retain female health workers concluded in three states.
  • Developed a concept paper on leveraging quality improvement through performance based incentive mechanisms. This paper has triggered a study to evaluate PRRINN MNCH quality improvement initiatives to be conducted by four Columbia University students.
  • Developed a TOR for UAM (Universal Anaesthetic Machine) pilot and contracted two consultants to lead the clinical study; pre-intervention Emergency Transport Scheme (ETS) studies and activities completed in all states.

Improved information and knowledge

  • HMIS data used for mid-year performance review and annual planning for 2012 in all programme states; draft training manual on use of NHMIS information for health programme managers developed
  • All M&E officers trained on DHIS

Knowledge Management

  • Discussion guide on community engagement approach drafted
  • An article on the Northern Nigeria Maternal, Newborn and Child Health Programme published in The Open Demography Journal
  • Featured in a Guardian story and blog on maternal mortality and in the Independent newspaper and on the DFID website for Mothers’ Day

M & E

  • Training information management system established
  • M&E  framework and reporting system enabled to timely respond to donors’ information requirements.

 

Increased demand for MNCH services

  • Collaboration with the Ministry of Religious Affairs (MoRA) and Islamic scholars to promote issues relating to women and children’s access to and utilization of MNCH services.  
  • A total of 8 State ministries/ departments/ agencies (MDAs) have included funds for MNCH demand-side issues in their budgets and partially led community engagement activities.
  • Equity related information captured through health management information system is informing management decision-making in all states. Gender disaggregated human resources data is also being used in planning human resources for health.
  • Successful community based service delivery (CBSD) pilots were completed in all states.  

 

Improved capacity at Federal Ministry level for state routine immunization

  • Assisted in strengthening formal systems for leveraging, accessing and utilising additional PHC funding and resources: GAVI, MSS, PHCUOR, MDG conditional grant, NHIS.
  • Supported NPHCDA core group to disseminate key findings of the study on PEI to identify reasons for unimmunized and zero dose children.
  • Following approval at the National Council for Health (NCH) (see output 1), SPHCDA established in 15 states and processes for establishment in additional 5 states on-going.
  • NPHCDA and Partners have bought into the programme’s position that RI strengthening is a key strategy for polio eradication and have incorporated RI into the 2012 Revised Emergency Action Plan for PEI.

 

2010 Achievements

Key achievements of PRRINN-MNCH during 2010 include the following (for more details see the 2010 Annual Report):

Goal and Purpose Indicator Targets

In comparison with the baseline data, the project has made significant strides in reaching the targets in the four PRRINN-MNCH states:

  • 314% increase or an additional 222,141 fully immunised children per annum
  • 431% increase or an additional 360,072 pregnant women appropriately immunised against tetanus per annum
  • 270% increase or an additional 24,748 women per annum attending ANC first visits in targeted facilities in the CEOC first clusters
  • 271% increase or an additional 13,998 women being delivered by SBAs per annum in targeted facilities in the CEOC first clusters
  • Polio cases in 2010 were 9 in the four states – down from the baseline of 237

Full details are available here.

Governance

 

  • State Primary Health Care Bill passed in Yobe and Zamfara (details here)
  • Memo/guidelines on ‘bringing PHC under one roofapproved by NPHCDA Board and memo prepared for National Council for Health (2011)
  • Establishment of a pooled health fund in Jigawa
  • MOUs signed in Yobe and Zamfara between the state government and UKaid and at LGA level (in the first clusters) between state/LGA government and PRRINN-MNCH (Katsina and Zamfara to follow in 2011)
  • Integrating approaches to MSP delivery, free MCH services and resource availability (e.g. from government, inclusive of NHIS, NPHCDA and MDG Fund)
  • Request and obtain UKaid’s approval for SAVI and SPARC to provide additional support for advocacy and institutional change in the PRRINN-MNCH supported states

Improved human resource policies and practices for PHC

 

  • Developed and updated a Human Resource Information System (HRIS) in all 4 states
  • Tracked retention of MSS Midwives (MWs)
  • Established high level Human Resources for Health ‘taskteams’ in the states

Improved delivery of MNCH services via the PHC system 

  • Reviving Kangaroo Mother Care (KMC) in the three MNCH states
  • Close collaboration with NPHCDA on MSS resulting in significantly increased ANC and delivery attendance at health facilities
  • Introduced maternal death audits

Operational research evidence  

  • State OR governance and institutional capacity development ongoing
  • Nahuche HDSS fully functional
  • Performance-based financing (PBF) studies initiated

Improved information and knowledge

  • Utilising data from the routine Health Management Information System (HMIS) for a variety of purposes
  • Finalising and reporting quarterly on the PRRINN-MNCH Monitoring and Evaluation (M&E) framework
  • Producing a variety of Knowledge Management materials

Increased demand for MNCH services  

  • Increase in the number of communities involved in community engagement from 68 to 300
  • Under the Emergency Transport Scheme (ETS), 1,214 women (milestone was 150) transported to hospital for maternal emergencies in 2010; a total of 4.2m Naira was saved with 145 families receiving EMC loans and 239 families receiving EMC grants
  • Two critical studies (financial barriers to access and clustering of mortality) led to a revised approach and increased advocacy

Improved capacity at Federal Ministry level for state routine immunization  

  • Ensuring the ongoing provision and use of the GAVI funds
  • Maintaining key links with federal level bodies and thus assuring interest in PRRINN-MNCH state level activities (e.g. ‘Bringing PHC under one roof’)

 

2009 Achievements

Key achievements of PRRINN-MNCH during 2009 include the following (for more detail see the 2009 Annual Report):

State strengthening

  • Our project strengthened state and Local Government Authority (LGA) governance of Primary Health Care (PHC) systems geared to Maternal, Newborn and Child Health (MNCH)
  • We facilitated dialogue amongst all stakeholders in three states (Yobe, Zamfara and Katsina), leading to all PHC services being brought under one roof. Yobe has progressed further and legislation is currently being considered by the State Assembly.
  • All states have embarked on planning and budgeting exercises at state and LGA levels.
  • Initial work on a costed minimum service package for states has started and this will link with costing free MNCH services.

Improved human resource policies and practices for PHC

  • Our programme has completed Human Resource (HR) audits in all four states. HR committees are being established at state level to review and utilise the data from the audits for planning purposes.

Improved delivery of MNCH services via the PHC system

  • In each state, we have identified a Comprehensive Emergency Obstetric Care (CEOC) cluster and have completed an audit of services, infrastructure and equipment
  • Initial work has started on developing a sustainable drug supply system in all states.
  • Transport policies have been developed and are in the process of being implemented.

Operational research evidence

  • Our operational research has provided evidence for PHC stewardship, MNCH policy and planning, service delivery, and effective demand
  • The learning LGA site in each state has been identified and teams from each state have had the opportunity to learn from similar work in Navrongo, Ghana.

Improved information and knowledge

  • Information and knowledge generated from the project is now being used in policy and practice
  • We have started work on strengthening information management systems with a focus on the CEOC cluster facilities.
  • The programme’s knowledge management strategy is being closely aligned with the monitoring and evaluation strategy to ensure that what is reported is strongly grounded in evidence.

Increased demand for MNCH services

  • The programme’s community mobilisation activities have focused on communities aligned with the CEOC clusters.
  • The focus of communication activities has been on knowing danger signs during pregnancy and delivery, and on understanding the importance and timing of immunization.

Improved capacity at Federal Ministry level for state routine immunization

  • PRRINN-MNCH supported the National Primary Health Care Development Agency (NPHCDA) in its restructuring exercise. Following this, a strong relationship with NPHCDA has developed.
  • The programme also provided assistance to enhance the distribution and accountability of funds from the Global Alliance for Vaccines and Immunization (GAVI).