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...
Research briefThe Pathway to Improved Maternal and Newborn Health Outcomes in Gombe State, Nigeria
Use of data for maternal and newborn health in Gombe State, Nigeria (Data from February 2016)
Journal articleDistrict decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia
A study of the feasibility of using a data informed platform for health in a district health systems context in five districts of India, Nigeria and Ethiopia.
ReportChanges in maternal and newborn health care in Gombe State, Nigeria
Interactions between families and frontline workers – their frequency, quality, and equity – and coverage of interventions for mothers and newborns in Gombe State, Nigeria.
Research briefCatalysing scale-up of maternal and newborn health innovations: lessons from a case study in North-Eastern Nigeria
Research brief on lessons from a case study of scale-up in North-Eastern Nigeria
Blog PostHow can data improve implementation?
Learning from routine data Using routine monitoring and evaluation data to understand why innovations are not being used can help local maternal...
Blog PostOne house, two doors: Making sure survey numbers represent the people
What a compelling fact! We need facts like this. They help us to understand the health needs of a community and how we should be addressing them....
Journal articleAdding Content to Contacts: Measurement of High Quality Contacts for Maternal and Newborn Health in Ethiopia, North East Nigeria, and Uttar Pradesh, India
Families in high mortality settings need regular contact with high quality health services. This paper presents a method for estimating the population level coverage of high quality contacts.
ReportDissemination activity and impact of maternal and newborn health projects in Ethiopia, India and Nigeria
Report on the dissemination activity and impact of Bill & Melinda Gates Foundation implementation projects.
NewsHousehold, frontline worker and facility follow-up surveys begin in Ethiopia and Nigeria
The endline data, to be collected in April and May 2015, will be compared with baseline data collected in 2012, and any changes in healthcare...