Determinants of effectiveness of a novel community health workers programme in improving maternal and child health in Nigeria

尼日利亚新型社区卫生工作者计划改善孕产妇和儿童健康有效性的决定因素

• 批准号: MR/M01472X/1
• 负责人: Tolib Mirzoev
• 金额: $ 101.29万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM01472X%2F1
• 关键词: Determinants; effectiveness; novel; community; health

Improved mother and child health (MCH) continues to be an issue of international priority, particularly for sub-Saharan African countries. Evidence suggests that schemes involving Community Health Worker (CHWs) can be effective in improving the health of mothers and children. Although such schemes are implemented in some developing countries such as Bangladesh, to guide further developments, much better understanding is needed on what makes CHW programmes successful and under what circumstances. In Nigeria, despite significant improvements, mother and child health remains an issue of concern, particularly in rural areas where most vulnerable groups live. In 2012, the Federal Government of Nigeria established the Subsidy Reinvestment and Empowerment Programme (SURE-P) to invest the revenue from fuel subsidy reduction into a social security programme to improve lives of most vulnerable populations. One SURE-P component, implemented in selected facilities in each State, focuses on maternal and child health (SURE-P/MCH). The idea is that recruitment of CHWs, combined with infrastructure development, and improved availability of supplies and medicines, will improve access to quality health services, and ultimately, improve mother and child health. Since December 2012, Conditional Cash Transfers (CCT) have also been added at selected sites ('SURE-P/MCH+CCT'). These incentive payments to pregnant mothers are linked to use of health services at different stages: e.g. for antenatal care visits and facility deliveries. The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be achieved by investigating two implementations (i.e. with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will do so by:1.Developing an in-depth understanding of the context and the process of implementation of the interventions, including relations between health workforce and infrastructure and supplies;2.Identifying, assessing and comparing the intervention outputs (e.g. skills and practices of CHWs and efficiency of primary health care facilities) and outcomes (e.g. equitable access to quality MCH services and attainment of MCH outcome targets);3.Developing an empirically-based and theoretically-grounded model of complex relations between the people involved, context, implementation process, outputs and outcomes of the interventions;4.Developing transferable best practices for scalability (expansion within a broadly similar context) and generalizability (expansion to different contexts) of the interventions.This five-year research and development project will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, which were selected in consultation with the Federal MOH and SURE-P national programme officer. Selecting two states from different parts of the country will provide an opportunity for different contextual factors that affect the implementation and outcome from the programme to be better elucidated and ensure that the findings are generalisable to the entire country. Within each State we will select three Local Government Areas (LGAs) clusters: one with SURE-P/MCH, one with SURE-P/MCH+CCT and one with no intervention. In each State the two interventions will be assessed against each other and against the comparison (i.e. no implementation) site. We will work closely with local, State and Federal policymakers and practitioners, to generate answers that can be used to inform their policy decisions. We expect that better understanding of performance of the CHW programme in Nigeria will inform further strengthening of the existing programme, its replication within Nigeria, and other similar countries considering the implementation of CHW initiatives.

改善妇幼保健仍然是国际优先事项，特别是对撒哈拉以南非洲国家而言。有证据表明，涉及社区卫生工作者的计划可以有效地改善母亲和儿童的健康。尽管孟加拉国等一些发展中国家实施了此类计划，但为了指导进一步的发展，需要更好地了解CHW方案成功的原因以及在何种情况下成功。在尼日利亚，尽管情况有了重大改善，但母婴健康仍然是一个令人关切的问题，特别是在最弱势群体生活的农村地区。2012年，尼日利亚联邦政府设立了补贴再投资和赋权方案，将减少燃料补贴的收入投资于社会保障方案，以改善最弱势群体的生活。在每个州的选定设施中实施的一个SURE-P组成部分侧重于妇幼保健。其想法是，招募社区卫生工作者，再加上基础设施的发展，以及用品和药品供应的改善，将改善获得优质保健服务的机会，并最终改善母亲和儿童的健康。自2012年12月以来，在选定的地点（“SURE-P/MCH+ CCT”）也增加了有条件现金转移（CCT）。向孕妇发放的这些奖励与不同阶段的保健服务使用情况挂钩：例如产前检查和在医院分娩。该项目的目的是为加强和扩大社区卫生工作者方案提供信息。这将通过调查尼日利亚社区卫生福利方案的两种实施方式（即有条件现金转移和无条件现金转移）来实现，以了解哪些因素在何种条件下促进公平获得优质服务，并改善孕产妇和儿童健康成果。我们将通过以下方式实现这一目标：1.深入了解实施干预措施的背景和过程，包括卫生工作人员与基础设施和供应之间的关系; 2.确定、评估和比较干预措施的产出（例如社区卫生工作者的技能和做法以及初级卫生保健设施的效率）和成果（例如公平获得优质妇幼保健服务和实现妇幼保健成果目标）; 3.建立一个以实践为基础和理论为基础的模型，描述干预措施所涉及的人员、背景、实施过程、产出和结果之间的复杂关系; 4.为可扩展性开发可转移的最佳实践（在大致相似的背景下扩展）和普遍性这一为期五年的研究和发展项目将在尼日利亚的两个州实施，北部的尼日尔州和南部的阿南布拉州，这两个州是与联邦卫生部和SURE-P国家方案干事协商选定的。从该国不同地区选择两个州将提供一个机会，更好地阐明影响方案执行和成果的不同背景因素，并确保调查结果可推广到全国。在每个州内，我们将选择三个地方政府区域（LGAs）集群：一个有SURE-P/MCH，一个有SURE-P/MCH+CCT，一个没有干预。在每个州，将对两种干预措施进行相互评估并与比较（即未实施）地点进行评估。我们将与地方，州和联邦政策制定者和从业人员密切合作，以产生可用于告知他们的政策决定的答案。我们希望，更好地了解CHW方案在尼日利亚的绩效，将有助于进一步加强现有方案，在尼日利亚和其他考虑实施CHW倡议的类似国家推广该方案。

项目成果

"If you are on duty, you may be afraid to come out to attend to a person": fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.

• DOI: 10.1186/s12913-020-05747-9
• 发表时间: 2020-09-29
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Etiaba E;Manzano A;Agbawodikeizu U;Ogu U;Ebenso B;Uzochukwu B;Onwujekwe O;Ezumah N;Mirzoev T
• 通讯作者: Mirzoev T

Which mechanisms can explain how primary health workers are motivated? Insights from realist evaluation of SURE-P in Nigeria

哪些机制可以解释初级卫生工作者的积极性？

• 发表时间: 2019
• 作者: Ebenso, B

Quality of Maternal and Child Health data within the Health Management Information System in Nigeria: A post field reflection

尼日利亚健康管理信息系统中妇幼健康数据的质量：现场反思

• DOI: 10.13140/rg.2.2.22955.75047
• 发表时间: 2017
• 作者: Benjamin Uzochukwu

Security of health facilities as a determinant of provision and utilization of Maternal and Child Health services in Anambra state, Nigeria

尼日利亚阿南布拉州卫生设施的安全是提供和利用妇幼保健服务的决定因素

• 发表时间: 2019
• 作者: Etiaba, E.