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Nigeria

IDEAS works in Gombe State in north-east Nigeria and in Lagos State in the south-west.

In Gombe, we work under the umbrella of the Gombe Maternal and Newborn Health Partnership, led by the Gombe State Primary Health Care Development Agency.  Using multidisciplinary research methods that provide a rich source of data, we work with partners to try to continuously use data to improve health programmes while also conducting an evaluation of effects.

In Lagos, we collaborate with partners to understand how a quality improvement scheme that is implemented in public and private health facilities operates, and to generate lessons on whether and how health system context affects quality improvement.

Our findings contribute to the gap in implementation research on what works, why and how in getting life-saving interventions to families at scale. Findings are continuously 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.

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.  Working with the MNH Partnership in Gombe State, IDEAS uses survey and routine data sources to track progress at six-monthly intervals, making sure that data is available and accessible to inform decision making in the State.

Supporting local decision making

Together with the Gombe State Primary Health Care Development Agency, IDEAS has co-hosted six-monthly ‘Data-driven Learning Workshops’ since 2016.  These workshops represent a learning tool to help strengthen data-informed programme decision making.

Partners come together for collective sharing and review of progress in the previous six months, reflecting on targets and the inter-dependency of demand and supply side efforts.  Following this reflection, the group makes decisions about what new actions are needed to drive further 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 receive, and the measurement of the quality of care provided (including respectful care) lacks standardised methods. IDEAS aims to improve the measurement of priority indicators for maternal and newborn health through two work streams.  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, we conduct research on methods for linking household and facility data to produce actionable measures of effective coverage for maternal and newborn care.

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.

The study focusing on sustainability and scalability of the scheme has generated important knowledge on sustaining health programmes in low-income settings. The study enabled implementing partners to introduced real time improvements to the scheme. Overall, it builds 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
Listening to Gombe Mothers

Feedback from patients about their experience of health care is a critically important step to improving quality of care.  But mechanisms for...

Journal article
Half-way there: positive steps in maternal and newborn care in Northeast Nigeria

This IDEAS-led study, authored by Josephine Exley et al and published in BMJ Open, offers unique insights into the quality of care provided to...

Journal article
“Everything is from God but it is always better to get to the hospital on time”

Zelee Hill and her co-authors aimed to identify facilitators and barriers for women to deliver their babies in health facilities in Gombe State,...

News
In memory of Deepthi Wickremasinghe

Deepthi was a Research Fellow, specialising in qualitative research, systematic literature reviews and information and knowledge...