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 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.
IDEAS’ work in Gombe State is led by 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:
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 tracked 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 generated the primary data required to populate this dashboard and worked with partners to reflect on progress.
In addition, IDEAS primary data collected in intervention and comparison areas was used to evaluate progress in the state against a set of priority indicators for maternal and newborn health. Whilst data collection has been completed final results are published on a rolling basis.
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 developed and supported a Gombe State results framework that combined population level coverage with implementation targets. This was populated every six-months with estimates generated by IDEAS’ surveys, monitoring data provided by implementation partners and routine government data. Collectively, partners reviewed each results framework update at ‘Data-driven Learning Workshops’ and used it as a learning tool with which to improve programme decision making.
At these workshops partners came together for collective sharing and review of the most recent results, and a reflection on the targets and the inter-dependency of grantees’ efforts. This was followed by consultation on the decisions needed to drive change. IDEAS provided technical support in the interpretation and use of data, including focussed actions that aimed to support improvement in the quality of routine data sources.
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.
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.
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.
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