Abt Associates-led projects in Nigeria are improving the health of women, children, and families through malaria prevention, family planning, health system improvement, and partnerships involving the private sector, government, and others.
The health of Nigerians – in particular poorer women and children – is a primary focus of the Abt Associates-led projects in this West African nation. Abt’s projects in Nigeria are ensuring reliable drug supplies, improving access to key maternal and child health care services, helping women to plan their reproductive futures, and strengthening both the public and private health sectors.
“Abt Associates’ mission is to improve the lives and economic well-being of people worldwide,” said Diana Silimperi, MD, Abt division vice president for International Health. “Our work in Nigeria is a prime example of how we are fulfilling this goal.”
PATHS2: Better Maternal and Child Health through Partnerships, Planning, and Innovation
PATHS2, led by Abt Associates, is a six-year national health program funded by UKaid from the Department for International Development. The project is focused on five states: Enugu, Jigawa, Lagos, Kaduna, and Kano.
Alhaji Zubairu Idris (second from left), the village head of Ngeide in Kaduna State, receives donations from a member of the community for the Emergency Maternal Fund scheme, en effort facilitated by the
Partnership for Transforming Health Systems 2 (PATHS2) project, led by Abt Associates and funded by the U.K. Department for International Development. Very poor members of Ngeide can borrow from the fund and repay later without interest to help cover the costs of caring for maternal and child health emergencies.
Photo credit: PATHS2
Abt’s PATHS2 Program Director Mike Egboh is personally motivated to ensure that Nigerian women have access to family planning and maternal health care. His mother died during labor for her 11th pregnancy. “Many of us here in Africa were not planned children,” Egboh said. "I've seen women being wheeled out of the labor room dead. I stayed at a hospital one day – and within three hours there were five dead bodies. Five.”
PATHS2 is improving Nigerian health care for women and children by fostering community ownership of pro-poor health projects and increasing cooperation between the public and private sector. Specifically, PATHS2:
- Brokered an agreement with Nigeria’s National Youth Service Corps to deploy doctors to PATHS2-supported rural health facilities to provide basic emergency obstetric care;
- Facilitated the creation of Emergency Maternal Fund schemes in 50 communities supported by their residents. In these arrangements very poor residents can borrow from the fund to help cover the costs of caring for maternal and child health emergencies. The loans are interest-free;
- Helped stabilize supplies of quality, authentic pharmaceuticals in 1,861 health care facilities by creating drug revolving funds (DRFs). After an initial capital investment by PATHS2, drug supplies are replenished with the money collected from the drug sales plus a small additional administrative charge.
- Created the Emergency Transport Scheme, an agreement in which Nigeria’s transport union recruits and trains taxi drivers as volunteers to take pregnant women to health facilities during obstetric emergencies.
“Through better access to care, a stronger health care safety net, and community partnerships PATHS2 is a contributor to progress on maternal and child health in Nigeria,” Egboh said.
SHOPS Project Works With Private Providers to Improve Family Planning
In this training session on long-acting and reversible methods, providers gain hands-on experience inserting and removing intrauterine devices and implants using models.
Photo credit: Adebola Hassan
Family planning is essential to reducing maternal mortality and Nigeria has one of the highest rates in the world.
“Private health care providers are the source of 60 percent of family planning services in Nigeria,” said Susan Mitchell, SHOPS project director. “They are essential to meeting the unmet need for family planning and improving health outcomes.”
Increasing Availability of Services
SHOPS aims to increase the supply of quality family planning counseling and service provision by training private providers, who, busy running their own clinics, have limited access to training opportunities. The team has trained private providers working in more than 700 private facilities across six states thereby expanding access to a broader method mix, in particular implants and intrauterine devices (IUDs).
“We are improving the capacity of private providers to ensure that the supply side is where it should be,” said Ayodele Iroko, the SHOPS Nigeria chief of party, who has expertise in family planning programming and a degree in business administration.
The trainings offered include a range of family planning and maternal and child health modules. To expand access to a broader method mix, the training focuses on long-acting methods.
A spray operator is preparing to begin spraying in Doma, Nasarawa state, Nigeria, as part of the Africa Indoor Residual Spraying (AIRS) project.
Photo credit: Devaan Hanmation
Providers are quick to apply the skills they learn. For example, one of the providers who took a recent training told the story of one patient, a 33-year-old mother of three, who stopped using an injectable due to negative side effects. After taking the counseling course, the provider was able to give her client the reassurance she needed to continue on family planning, this time using an implant.
“Family planning goes a long way to save lives,” Iroko said. “It is about … giving the children who are already alive the chance to fulfill their destinies.”
AIRS: Preventing Malaria by Engaging Communities
Nigeria experiences more malaria deaths than any other country – more than 300,000 per year, nearly 100,000 more than HIV and AIDS. That is partly because Nigeria is the most populous country in Africa, but also because malaria-transmitting mosquitoes live in virtually all of the country.
Population protected (March 2012 to April 2013): 346,798
Structures sprayed: 97.5 percent of target
Children under five protected: 67,204
Pregnant women protected: 16,733
AIRS, funded by USAID and led by Abt Associates, engages communities to ensure the effectiveness of its indoor residual spraying (IRS) campaigns, emphasizes environmental compliance – including careful handling of chemicals and spraying equipment – and includes entomological monitoring with training of local staff to track insecticide resistance and to adjust spraying appropriately.
An Economic Ripple Effect
In 2012 and 2013 AIRS Nigeria introduced and piloted a model for an IRS program at the state and local levels in Nasarawa state. Local young people who worked for the IRS campaign used their earned money to solve a lot of problems in their families, said Alh. Bawa Ajegena, director of Primary Health Care in Nasarawa Eggon local government (LGA) area during the 2012 spray cycle.
Alh. Bawa Ajegena (right), director of Primary Health Care in Nasarawa Eggon local government area in 2012 praised the indoor residual spraying carried out by AIRS Nigeria, led by Abt Associates. Ajegena said the campaign has greatly reduced the number of mosquitoes.
Photo credit: AIRS Nigeria
“[One boy] used his IRS allowances to pay his fees and continued his education,” the future of which had been in doubt, Ajegena said.
Ajegena, who happened to be transferred to Doma LGA, also in Nasarawa state, in 2013, also said the spray campaign there was very effective. “The insecticide did not only kill the mosquitoes, but also killed snakes and cockroaches – to the amazement of everyone,” he said.
Focusing on Entomological Monitoring
In 2014, upon request from President’s Malaria Initiative (PMI), entomological surveillance will be the main focus of the AIRS Nigeria program.
The project will capture PMI entomology indicators in all six geopolitical zones of the country, and these will be compared by the type of malaria control interventions and coverage across all geopolitical and most ecological zones of the country. Through activities planned for 2014, information will be collected to help the National Malaria Control Program in making data-driven decisions for programming vector control activities.
HFG: Tackling HIV with Technology
The Health Finance and Governance (HFG) project, led by Abt Associates and funded by USAID, is working with the Nigerian government to mobilize additional public funding for national HIV programming. This work includes generating financial evidence on the costs, impact, and sustainability of HIV efforts, using this evidence to mobilize additional resources, and ensuring efficient, effective, and equitable use of national HIV programming resources.
In Nigeria, health workers are using smartphones at more than 500 facilities to more accurately diagnose and treat tuberculosis (TB) as a result of a successful USAID pilot program under the Health Systems 20/20 project – HFG’s predecessor project, also led by Abt – to integrate mobile technology into the TB supervision process. Under the HFG project, the program has scaled up to additional four states – Rivers, Ogun, Abuja, and Kwara – reaching 300 more facilities. In its second year, the project will begin transitioning the management of this activity to the Nigerian government in order to ensure complete country ownership.
