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Using evidence to reduce maternal deaths in Nigeria

June 10, 2016

In 2010, some 40,000 Nigerian women died in childbirth — 14% of the world’s total maternal deaths. In many rural areas, women and girls marry young and put in long hours of gruelling domestic labour — grinding meal, fetching firewood and water, tilling and selling crops — well into late stages of pregnancy.

After two years of extensive consultation, the Nigeria Evidence-based Health System Initiative (NEHSI) was launched in 2008 as a joint effort of the Government of Nigeria, IDRC, and the Canadian International Development Agency. It strengthens health information systems in two Nigerian states —Bauchi and Cross River — and trains decision-makers to use local evidence in planning and managing health services. Improving maternal and child health outcomes is a top priority.

The initiative uses a social audit and implementation research methodology: it gathers input from multiple stakeholders, then rolls out and monitors the effectiveness of evidence-based health responses over time. According to Neil Andersson of the research and training organization CIET, this serves as a reality check: a social audit takes stock “of where we are with our assumptions, guesses, and intentions. The idea is to produce hard evidence about what works, who is left out, and what will make up the shortfall.” 

NEHSI weaves together many strands of capacity strengthening to build the confidence, skills, and expertise of health decision-makers. In Giade, a local government area in Bauchi state, skilled attendants assist less than 15% of births. The NEHSI team implemented a community surveillance system at the request of local officials. Household monitoring visits are structured to identify pregnant women and newborns at risk. Community health extension workers interview pregnant women and, separately, their husbands. Over a series of visits, the workers discuss maternal and child health needs, using findings from an earlier baseline study as a starting point. With smartphones that confirm geographic location, they capture responses to a short list of questions, and relay them directly to headquarters in the state capital. This identifies high risk cases in real time, allowing for immediate follow up. The information can also be shared with health centres and collated for planning and policy purposes.

Results so far suggest that visiting women in their homes to discuss pregnancy may be an inexpensive way to save women’s lives. In 8,000 households in Giade, maternal deaths were 3.8 % among those who received one visit, 0.8% among those who received two, with no deaths recorded among those who received three home visits.

Beyond its impact on maternal health, NEHSI is changing the way the health system works. When it ends in 2014, the project will have laid the groundwork for scaling up an evidence-based model for decision-making in Nigeria. The research has shown that informing and involving communities can directly improve health outcomes. By working with local and state government partners, it ensures the tools and training leave a legacy of institutional capacity.

    "The idea is to produce hard evidence about what works, who is left out, and what will make up the shortfall." 

    Neil Andersson, Executive Director of CIET, leads several major components of the Nigeria Evidence-based Health System Initiative.

    Neil Andersson