In Gombe, we worked 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 worked with partners to try to continuously use data to improve health programmes while also conducting an evaluation of effects.
In Lagos, we collaborated 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 contributed to the gap in implementation research on what works, why and how in getting life-saving interventions to families at scale.
Research areas in Nigeria are:
A government-led partnership came together in Gombe State, northeast Nigeria, to improve outcomes for mothers and newborns. Actions across multiple health system building blocks were coordinated and progress reviewed at regular intervals. Data was a key input to partner decision-making. Overall, there was improvement in indicators on access to care and on the quality of facility-based care, and government leadership was seen to be crucial, although the mechanism for sustaining progress remained uncertain.
Improving coverage measurement
Measuring effective coverage for maternal and newborn health
Our research aimed to improve the measurement of priority indicators for maternal and newborn health, including quality of care measures. A number of problems needed to be addressed: (i) generating greater clarity around what it was possible to measure, and how; (ii) understanding which data should be used to drive decisions; (iii) developing methods for linking household data on access to care with facility data on quality of care; and (iv) creating actionable effective coverage measures for facility-based childbirth care.
Improving measurement for respectful maternity care
We aimed to study positive and negative facility childbirth experiences and to determine best practices for measuring respectful maternity care. In Gombe State, Nigeria, we did research to understand 1) mistreatment during facility childbirth, 2) the utility women placed on attributes of childbirth care experiences, 3) the validity of measures of childbirth care experiences derived from exit interviews, 4) the validity and acceptability of capturing childbirth care experiences though telephone interviews, 5) the feasibility and acceptability of primary healthcare provider-led phone follow-up with mothers shortly after childbirth.
Fostering innovation sustainability
We studied how to scale-up and sustain maternal and newborn health innovations in Ethiopia, northeast Nigeria and Uttar Pradesh in India. We defined ‘scale-up’ as the adoption of donor-funded health innovations beyond original programme districts, and ‘sustainability’ as the longer-term implementation of donor-funded innovations that have been scaled-up.
Understanding Quality improvement
Quality improvement collaboratives are increasingly popular in low- and middle-income settings, often being implemented on a large scale. However, relatively little is known about the influence of context on implementation; consequently, new implementers may not benefit from the knowledge of what worked, what was adapted, and why. Working with partners in Lagos State, Nigeria, we studied the implementation of a complex quality improvement initiative that was driven by government and supported by a non-governmental organisation. Evidence revealed considerable influence of internal and external contextual factors, necessitating adaptations throughout implementation.
Blog PostFirst results from the Gombe State Maternal and Newborn Health Partnership
Together with implementation partners the Society for Family Health, the SAQIP project of PACT Nigeria and Evidence for Action Mamaye, IDEAS has...
Journal articleStrong political leadership drives change
This paper, recently published in BMJ Open, sets out to quantify changes in the coverage, quality and equity of essential care for mothers and...
Journal articleFrom Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementing Context
Access to maternal and newborn care is increasing but due to the poor quality of care provided this doesn’t necessarily lead to fewer avoidable...
Blog PostHow do we measure women’s experience of childbirth care?
When women go to a health facility to deliver, they expect to be looked after – to receive all the clinical care necessary to ensure their...
NewsCritically examining quality-adjusted coverage measures
Improving coverage measurement continues to be a key area of ongoing research with the IDEAS team. Currently the team is working in collaboration...
Journal article‘A seamless transition’: how to sustain a community health worker scheme
This paper, published in Health Policy and Planning, presents a qualitative study focussing on the Village Health Worker (VHW) Scheme’s...
Journal articleImproving the use of focus group discussions in low income settings
This paper authored by Pauline Scheelbeek et al and published in BMC Medical Research Methodology describes how six exercises were used in 32...
Journal articleUsing social media to improve routine data quality metrics
How is this all linked to social media? The study, published in BMJ Open, measured changes in data quality metrics before and after the...
Blog PostListening 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 articleHalf-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...