Identifying inequities in maternal and child health through risk stratification to inform health systems strengthening in Northern Togo

Abstract BackgroundThis study expands the current body of knowledge by investigating the impact of the Global Health Initiatives (GHI) on the Nigerian health system. Using robust multilevel analytic approaches, this study examined system-wide impacts of foreign aid on the Nigerian health system– a country that has witnessed substantial Development Assistance for Health disbursements in the last two decades, yet has one of the worst maternal and child health indices globally. Most of the health aid to Nigeria has been for HIV programs; and has sparked debates among stakeholders. Critics have asserted the possibility that HIV aid might not be working and could have had unintended negative consequences on the delivery of non-HIV services. Others maintained that such prioritized attention to HIV could have had a crowding-out or negative spillover effect on the delivery of other health programs in Nigeria. Thus, the focus of this study is to ascertain the nature of the spillover effect of HIV aid on the delivery of maternal and child health services in NigeriaResultsThis study identified that donor HIV financing to Nigeria increased up to 2012, and decreased steadily afterwards between 2008 – 2018. This was suggested to be linked to PEPFAR priority shift to health systems strengthening in the second round of their funding cycle. This study also identified a negative spillover effect of HIV-specific aid on the delivery of non-HIV services, and is suggested to be attributed to the prioritized attention given to HIV programs by global health systems.ConclusionsStudy findings provide systematic evidence to inform policy on the frameworks for developing a national roadmap for the effective alignment of GHIs’ coordinating mechanisms with national health priorities. Future studies should explore the effects of the Development Assistance for Health among low- and middle-income countries including Nigeria to provide evidence for policy, and substantiate how the growing interests in health systems strengthening is overcoming vertical programs and fostering systemic improvements. Government should identify turnaround strategies to strengthen Nigerian health systems for the Sustainable Development Goals, and formulate policies that improve the effectiveness of GHIs in Nigeria.

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FIMR and Other Mortality Reviews as Public Health Tools for Strengthening Maternal and Child Health Systems in Communities: Where Do We Need to Go Next?

Maternal and Child Health Journal ◽

10.1023/b:maci.0000047424.62781.0d ◽

2004 ◽

Vol 8 (4) ◽

pp. 259-268 ◽

Cited By ~ 7

Author(s):

Ellen Hutchins ◽

Holly Grason ◽

Arden Handler

Keyword(s):

Public Health ◽

Child Health ◽

Health Systems ◽

Maternal And Child Health ◽

And Child Health

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Lessons for responding to COVID-19, from Exemplars in Under-five Mortality Reduction

Gates Open Research ◽

10.12688/gatesopenres.13165.1 ◽

2020 ◽

Vol 4 ◽

pp. 120

Author(s):

Lisa R Hirschhorn ◽

Nathaniel Gerthe ◽

David E Phillips ◽

Oliver Rothschild ◽

Manpreet Singh ◽

...

Keyword(s):

Child Health ◽

Health Services ◽

Health Systems ◽

Maternal And Child Health ◽

Health Workers ◽

Child Health Services ◽

Data Systems ◽

Under Five ◽

Success Stories ◽

And Child Health

COVID-19 may not have the same direct effects on children as it does on older adults, but its indirect effects still pose a threat to child health, by disrupting delivery of routine health services like immunizations. This has happened during previous crises, and early indications point towards similar disruptions due to the coronavirus pandemic. To mitigate this, countries need to build resilient health systems capable of maintaining essential maternal and child health interventions, while also responding to COVID. How can this be accomplished? To find some answers, we can learn from countries in the past who improved health outcomes in the face of challenging circumstances. Specific to child health, countries with positive-outlier performance in reducing under-five mortality provide helpful strategies. These lessons include a clear national plan that drives rapid response, leveraging existing data systems to inform decision-making, engaging communities via community health workers, and focusing on equity. Today, countries around the world are facing the challenge of responding to the pandemic while building resilient health systems that continue to deliver invaluable maternal and child health services. Studying lessons from previous success stories can help inform the road ahead.

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Building on momentum from the global campaigns: an exploration of factors that influenced prioritization of stillbirth prevention at the national level in Uganda

Globalization and Health ◽

10.1186/s12992-021-00724-1 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Eric Ssegujja ◽

Michelle Andipatin

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Low Income ◽

National Level ◽

Health Systems Strengthening ◽

Low Income Countries ◽

Health Programming ◽

Policy Community ◽

Document Review ◽

And Child Health

Abstract Background Of the close to 2.6 million stillbirths that happen annually, most are from low-income countries where until recently policies rarely paid special attention to addressing them. The global campaigns that followed called on countries to implement strategies addressing stillbirths and the adoption of recommendations varied according to contexts. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda. Methods The study employed an exploratory qualitative design adopting Shiffman’s framework for political prioritization. Data collection methods included a document review and key informants’ interviews with a purposively selected sample of 20 participants from the policy community. Atlas. Ti software was used for data management while thematic analysis was conducted to analyze the findings. Findings Political prioritization of stillbirth interventions gained momentum following norm promotion from the global campaigns which peaked during the 2011 Lancet stillbirth series. This was followed by funding and technical support of various projects in Uganda. A combination of domestic advocacy factors such as a cohesive policy community converging around the Maternal and Child Health cluster accelerated the process by vetting the evidence and refining recommendations to support the adoption of the policy. The government’s health systems strengthening aspirations and integration of interventions to address stillbirths within the overall Maternal and Child Health programming resonated well. Conclusions The transnational influence played a key role during the initial stages of raising attention to the problem and provision of technical and financial support. The success and subsequent processes, however, relied heavily on domestic advocacy and the national political environment, and the cohesive policy community.

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Improving maternal and child health systems in Fiji through a perinatal mortality audit

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2014.11.010 ◽

2015 ◽

Vol 129 (2) ◽

pp. 165-168 ◽

Cited By ~ 2

Author(s):

Shanti Raman ◽

Alexandra Iljadica ◽

Rajat Gyaneshwar ◽

Rigamoto Taito ◽

James Fong

Keyword(s):

Child Health ◽

Perinatal Mortality ◽

Health Systems ◽

Maternal And Child Health ◽

And Child Health

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Did an Intervention Programme Aimed at Strengthening the Maternal and Child Health Services in Nigeria Improve the Completeness of Routine Health Data Within the Health Management Information System?

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.226 ◽

2020 ◽

Author(s):

Benjamin Uzochukwu ◽

Tolib Mirzoev ◽

Chinyere Okeke ◽

Joseph Hicks ◽

Enyi Etiaba ◽

...

Keyword(s):

Quantitative Analysis ◽

Child Health ◽

Health Systems ◽

Health Workers ◽

Health Management ◽

Health Systems Strengthening ◽

Management Information ◽

Data Completeness ◽

And Child Health

Background: During 2012-2015, the Federal Government of Nigeria launched the Subsidy Reinvestment and Empowerment Programme, a health system strengthening (HSS) programme with a Maternal and Child Health component (Subsidy Reinvestment and Empowerment Programme [SURE-P]/MCH), which was monitored using the Health Management Information Systems (HMIS) data reporting tools. Good quality data is essential for health policy and planning decisions yet, little is known on whether and how broad health systems strengthening programmes affect quality of data. This paper explores the effects of the SURE-P/MCH on completeness of MCH data in the National HMIS. Methods: This mixed-methods study was undertaken in Anambra state, southeast Nigeria. A standardized proforma was used to collect facility-level data from the facility registers on MCH services to assess the completeness of data from 2 interventions and one control clusters. The facility data was collected to cover before, during, and after the SURE-P intervention activities. Qualitative in-depth interviews were conducted with purposefully-identified health facility workers to identify their views and experiences of changes in data quality throughout the above 3 periods. Results: Quantitative analysis of the facility data showed that data completeness improved substantially, starting before SURE-P and continuing during SURE-P but across all clusters (ie, including the control). Also health workers felt data completeness were improved during the SURE-P, but declined with the cessation of the programme. We also found that challenges to data completeness are dependent on many variables including a high burden on providers for data collection, many variables to be filled in the data collection tools, and lack of health worker incentives. Conclusion: Quantitative analysis showed improved data completeness and health workers believed the SURE-P/MCH had contributed to the improvement. The functioning of national HMIS are inevitably linked with other health systems components. While health systems strengthening programmes have a great potential for improved overall systems performance, a more granular understanding of their implications on the specific components such as the resultant quality of HMIS data, is needed.

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