AFABEM Study
Nigeria has one of the highest estimated numbers of maternal death in 2017 with approximately 67,000 maternal deaths accounting for 23% of all global maternal deaths.1 Likewise, with a neonatal death of 270,000, Nigeria is amongst the top 10 countries with the highest numbers of neonatal deaths. There is no doubt that Nigeria will have to make concerted efforts to reduce preventable maternal, newborn and child deaths if it is to be on track to achieving SDG 3 by 2030. Improving quality of care has been identified by WHO as a priority to addressing preventable maternal and child mortality. This is in addition to other global initiatives such as the strategies towards Ending Preventable Maternal Mortality (EPMM), Every Newborn Action Plan (ENAP), and the new Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016–2030) for the post-2015 Sustainable Development Goal era.
The Federal Government of Nigeria’s commitment to achieve Universal Health Coverage and Sustainable Development Goals (especially Targets 3 and 5) by 2030, led to the adoption of the Reproductive, Maternal, Newborn, Child Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N) multi-stakeholder partnership coordination platform on Monday, 12th October 2020. The key aims of the RMNCAEH+N platform is to reduce preventable death and improve the health and well-being of mothers, newborn, and children.
Assessment of quality of care involves assessing the quality of structure, quality of process and quality of outcome. Likewise, provision of quality care involves effective use of both clinical and non-clinical interventions, availability of highly skilled human resource, positive attitude of health providers operating in a strengthened health infrastructure. In addition, Good-quality care is integral to the right to health and the route to equity and dignity for women and children.Nigeria has one of the highest estimated numbers of maternal death in 2017 with approximately 67,000 maternal deaths accounting for 23% of all global maternal deaths.1 Likewise, with a neonatal death of 270,000, Nigeria is amongst the top 10 countries with the highest numbers of neonatal deaths. There is no doubt that Nigeria will have to make concerted efforts to reduce preventable maternal, newborn and child deaths if it is to be on track to achieving SDG 3 by 2030. Improving quality of care has been identified by WHO as a priority to addressing preventable maternal and child mortality. This is in addition to other global initiatives such as the strategies towards Ending Preventable Maternal Mortality (EPMM), Every Newborn Action Plan (ENAP), and the new Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016–2030) for the post-2015 Sustainable Development Goal era.
The Federal Government of Nigeria’s commitment to achieve Universal Health Coverage and Sustainable Development Goals (especially Targets 3 and 5) by 2030, led to the adoption of the Reproductive, Maternal, Newborn, Child Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N) multi-stakeholder partnership coordination platform on Monday, 12th October 2020. The key aims of the RMNCAEH+N platform is to reduce preventable death and improve the health and well-being of mothers, newborn, and children.
Assessment of quality of care involves assessing the quality of structure, quality of process and quality of outcome. Likewise, provision of quality care involves effective use of both clinical and non-clinical interventions, availability of highly skilled human resource, positive attitude of health providers operating in a strengthened health infrastructure. In addition, Good-quality care is integral to the right to health and the route to equity and dignity for women and children.
The aim of this research was to identify facilitators and barriers to effective governance and implementation of quality of care of RMNCH services at tertiary, secondary and primary health care facilities in 4 states (Kano and Sokoto States in the northwest; and Borno and Yobe States in the northeast) in Nigeria. Effective governance refers to all the decisions, arrangements and practices in an organization that supports maintenance of system integrity and functioning. Whilst implementation is the process of executing or turning a plan into effect.
The objectives of the research were:
- To describe the status for RMNCH QoC in 2 states (Kano and Sokoto States)
- To assess the barriers to effective governance and implementation of RMNCH QoC in 4 States. (Kano, Sokoto, Borno & Yobe)
Study Site: Four states, 2 (Kano and Sokoto) in the northwest and 2 (Borno and Yobe) in the northeast.
A cross-sectional mixed methods study design was used to address the specific objectives detailed above.
Study Procedures
Data collectors and supervisors were trained on both survey and qualitative interviews. They undertook all data collection activities, and each collector was supplied with a tablet provided by the project. The tools were hosted on the Kobo collect app. All data were collected directly onto the tablets.
Given the nature of the assessments/interviews, all data collectors and supervisors had a health background. They were graduates of health-related courses or social sciences. The training was conducted over four days and involved all data collectors, supervisors, and research team members. The training employed a participatory/role play, adult-centered approach; and included use of interviewing techniques using the survey instruments. The tools were pre-tested during the training a different HFs from the selected ones.
Prior to data collection, the research team members conducted advocacy to key stakeholders responsible for the provision of RMNCH services in the 2 states to inform them of the research and sought permission to conduct the various research activities. Advocacy was also done to the selected health facilities.
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Objective |
Data Collection Tool |
Sample Size |
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Northwest Nigeria: Kano, Sokoto
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Objective 1: To describe the status of QoC for RMNCH services at selected facilities |
Tool B: Focus group discussions with women attending family planning, antenatal care, and immunization clinics at selected facilities |
1 per type of participant per facility (6-10 participants per group) * 3 service areas *3 facilities per state * 2 states = 18 FGD |
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Tool C: Focus group discussion with husbands of women who gave birth at selected facilities in the last 6-8 weeks |
1 per facility (6-10 participants per group) * 3 facilities per state * 2 states = 6 FGD |
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Tool D: In-depth interviews with women with a live birth at selected facilities in the last 6-8 weeks |
2 per facility = 6 per state |
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Tool E: In-depth interviews with mothers of children recently discharged from sick newborn care units or emergency pediatric wards at selected facilities |
2 per facility = 6 per state |
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TOTAL |
24 FGDs, 24 IDIs |
Key informant interviews were conducted in Kano, Sokoto, Borno and Yobe States. Key stakeholders in each state included policymakers in the State Ministry of Health (SMOH), State Health Services Management Board (SHSMB) and State Primary Health Care Board (SPHCB) LGA Primary Health Care Coordinators and Zonal Health Directors. Other key stakeholders included the leadership in the health facilities including the medical directors or in-charge of PHC and matron in charge of ANC, labor ward/family planning and Special Care Baby Unit (SCBU)/Emergency Pediatric Unit.
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States |
Objective |
Data Collection Tool |
Participant Type |
Sample Size |
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Northwest Nigeria: Kano, Sokoto
Northeast Nigeria: Borno, Yobe |
Objective 2: Assess barriers to effective governance and implementation of RMNCH QoC at district and facility levels.
&
Objective 3: Assess facilitators for effective governance and implementation of RMNCH QoC at district and facility levels |
Tool F: Key informant interviews with state and local government stakeholders
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Commissioner of Health |
1 per state |
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Perm Secretary SMOH |
1 per state |
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Executive Secretary SPHCDA |
1 per state |
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Director General SHSMB |
1 per state |
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LGA MNCH Desk Officer |
1 per state |
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MNCH Desk Officers · Kano: QoC & RH · Sokoto: MNCH · Borno: QoC & RH · Yobe: MNCH |
2 in Kano 1 in Sokoto 2 in Borno 1 in Yobe
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SHMIS/ M&E Desk Officer |
1 per state |
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Medical Directors |
3 per state |
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Head of Maternity |
3 per state |
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Matron in Charge of ANC/FP |
3 per state |
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Matron in Charge of Labor ward |
3 per state |
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Matron in Charge of SCBU/ EPU/ Immunization |
3 per state |
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Zonal Health Directors |
3 per state |
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PHC Coordinators/Directors |
3 in Sokoto 4 in Kano 4 in Borno 3 in Yobe |
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TOTAL |
117 KIIs |
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