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 articleUnderstanding 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 PostA 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,...
Journal articleMaternal and newborn health improves in rural Nigeria, Ethiopia and India but inequities still exist
“Our findings have a both optimistic and pessimistic interpretation, in that families from all socioeconomic status groups benefited, but...
Journal articleMonitoring childbirth care in primary health facilities: a validity study in Gombe State, northeastern Nigeria
Antoinette Bhattacharya et al assessed twenty-five childbirth care indicators to validate health worker documentation and women’s...
Journal articleMapping complex interventions – lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India
This paper authored by Krystyna Makowiecka et al and published in BMJ Global Health al describes how government leadership to enhance maternal and...
Blog PostA 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 briefRecommendations 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...
Blog PostMonitoring the quality of care for Nigerian mothers and newborns using DHIS2
This blog was written by Antoinette Bhattacharya from the IDEAS team and first published on the HNN blog. Working with the government of...
NewsA conversation about DHIS2
IDEAS team member Krystyna Makowiecka speaks to Antoinette Bhattacharya about the work she has done in Gombe to look at the quality of routine...