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Nigeria

IDEAS works in Gombe State in north-east Nigeria using multidisciplinary research methods to provide a rich source of data for funders, governments and non-governmental organisations working in maternal and newborn health.
We also work in Lagos State on the evaluation of a Quality Improvement scheme in public and private health facilities.

Our findings contribute to the gap in implementation research on what works, why and how in getting life-saving interventions to families at scale. IDEAS’ research in Gombe State addresses the urgent need for better measurement and learning. Findings will be shared within the countries that IDEAS works and with groups around the world to contribute to best-practice in the measurement of quality, life saving health care for mothers and newborns.

IDEAS’ work in Gombe State is led by Country Coordinator Dr Nasir Umar and is implemented in conjunction with Data Research and Mapping Consult Ltd – IDEAS’ measurement, learning and evaluation partner in Gombe. The Gombe State Primary Health Care Development Agency provides leadership for translating findings into action.

Our work in Lagos State is led by Abimbola Olaniran in Lagos, working with the Health Strategy & Delivery Foundation (HSDF) to implement a process evaluation of a Quality Improvement initiative in public and private health facilities.

Research areas in Nigeria are:

Tracking progress

Focus on a core set of priority interventions is key to tracking progress in maternal and newborn health. Together with the Bill & Melinda Gates Foundation, a maternal and newborn health dashboard was created in 2014 . The dashboard tracks population level coverage indicators for contacts with health services and for life saving interventions, together with facility level indicators of service readiness to provide life saving care. At six-monthly intervals IDEAS generates the primary data required to populate this dashboard and works with partners to reflect on progress.

In addition, IDEAS primary data collected in intervention and comparison areas is used to evaluate progress in the state against a set of priority indicators for maternal and newborn health. Final results will be available in 2019.

Supporting local decision making

Beyond the maternal and newborn health dashboard, a more detailed results framework is an important tool to help local stakeholders identify and focus on key implementation objectives within a complex environment. Working with the State Primary Health Care Development Agency and Bill & Melinda Gates Foundation implementation projects, IDEAS has developed and supports a Gombe State results framework that combines population level coverage with implementation targets. This is populated every six-months with estimates generated by IDEAS’ surveys, monitoring data provided by implementation partners and routine government data. Collectively, partners review each results framework update at ‘Data-driven Learning Workshops’ and use it as a learning tool with which to improve programme decision making.

At these workshops there is collective sharing and review of the most recent results, and all the participants reflect on the targets and the inter-dependency of grantees’ efforts. This is followed by consultation on the decisions needed to drive change. IDEAS provides technical support in the interpretation and use of data, including focussed actions that aim to support improvement in the quality of routine data sources.

Improving coverage measurement

Measurement for maternal and newborn health faces many challenges, especially for care that is delivered around the time of birth. Women may not be able to accurately report on the clinical care that they received, and the measurement of the quality of care provided (including respectful care) lacks standardised methods. We aim to improve measurement of priority indicators for maternal and newborn health by comparing the coverage estimates derived from multiple sources. Using data from observation of births in health facilities as gold-standard we test the validity of maternal reports on care provided, and evaluate the reliability of different data sources to provide comparable estimates. In addition, methods for linking household and facility data to produce effective coverage measures of care are under development.

Fostering innovation sustainability

IDEAS carries out qualitative studies to assess what happens to donor-funded maternal and newborn health innovations that are scaled-up in the longer term and how the foundation and other donors can take steps to foster sustainability. One such innovation is the Village Health Worker scheme. This scheme introduces a new cadre of community-based health workers who provide information and support to families, to improve health care behaviours in the home and increase uptake of appropriate and timely health care services when required.

This work will generate important knowledge on sustaining health programmes in low-income settings, building on previous IDEAS’ studies of scale-up and the work of other academics, and responding to the Bill & Melinda Gates Foundation interest in scale-up both geographically and with a longer-term legacy.

Understanding Quality improvement 

Lagos State accounts for a significant proportion of the national burden of maternal and neonatal mortality because of its large population. To this end, Lagos State Ministry of Health and its agencies have been leading Quality Improvement (QI) initiatives in health facilities within the state.

While QI health interventions are increasingly being implemented in diverse contexts there is limited evidence about how generic QI health interventions can be adapted to suit different contexts. The Lagos QI Collaborative that delivers QI in three distinct facility environments, Primary Healthcare Centres (PHCs) and both public and private hospitals, presents a unique opportunity to generate evidence on how to adapt a single intervention to fit different contexts. The process evaluation will cover all three collaboratives using both quantitative and qualitative methods.

We hope that findings from this evaluation will generate the needed evidence to guide scaling-up the intervention to all facilities within the state. More broadly, the findings could serve as a guide for adapting the intervention to other states in Nigeria and countries with a similar context.

Published content

Blog Post
“I felt like I should have delivered at home”

The Northeast of Nigeria has some of the highest rates of maternal and newborn deaths in the world. Drastically reducing this number of...

Journal article
Understanding mistreatment during institutional delivery in Northeast Nigeria

There is growing evidence from Nigeria and around the world that women who deliver their babies in health facilities can experience mistreatment....

Blog Post
A new appreciation for data: Impressions from the MNCH partnership in Gombe State

For the IDEAS team working in Gombe, the past few months have again been a busy period. The last annual household survey was scheduled for August,...

Blog Post
A new partnership with the University of Lagos

The prototype phase of NHQI was implemented in Lagos between April 2015 and September 2017. To institutionalise gains from the prototype phase,...

Research brief
Recommendations from the Village Health Worker Scheme Sustainability Study

Much work has been done to ensure the sustainability of the scheme, yet there are still some areas of uncertainty, which it would be beneficial to...