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Nigeria

MEASURE Evaluation has been working in Nigeria since early 2000, with a wide breadth of activities and a highly skilled in-country staff. During Phase III, MEASURE Evaluation has provided assistance to activities addressing HIV/AIDS, orphaned and vulnerable children, malaria and other infectious diseases, while working to build capacity and strengthen the country’s health information system.

 

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DEMOGRAPHY

Population

177,155,754 (July 2014 est.)

Population Growth Rate
2.47% (2014 est.)

Age Structure
43.2 % (0–14 years)
19.3% (15–24 years)
30.5% (2554 years)
3.1% (5564 years)
3 % (65 years and over)

Death Rate
13.16 deaths/1,000 population

HIV-RELATED DATA

Adult HIV Prevalence
3.1 % (2012 est.)

People Living with HIV
3,400,000 (2012 est.)

OTHER RELEVANT DATA

Infant Mortality Rate
78 infant deaths/1,000 live births (2012 est.)

Total Fertility Rate
6 children born/woman (2012 est.)

Maternal Mortality Ratio
550 maternal deaths/100,000 live births – 2008-2012 reported (2010 adjusted = 630/100,000)

With an estimated population of more than 175 million, Nigeria is Africa’s most populous country. Experts also consider it one of the world’s fastest growing economies. These factors present both opportunities and challenges to strengthening the health sector in this West African country. Generally, Nigerians face many obstacles to receiving quality care. A shortage of doctors and nurses, lack of access to health services and the prevalence of numerous infectious diseases hinder Nigeria’s progress. “The health condition in Nigeria is highly deplorable,” said Kola Oyediran, a Senior M&E Advisor for MEASURE Evaluation. “Among the most common diseases in Nigeria are malaria, pneumonia, measles, gonorrhea, typhoid, tuberculosis, chicken pox, diarrhea and, more recently, AIDS.”

Life expectancy at birth is just over 52 years. In 2012, the estimated infant mortality rate was 78 deaths per 1,000 live births, and 12.4 percent of children die before the age of 5 (124 deaths per 1,000 live births). And with an estimated adult prevalence rate of 3.1 percent in 2012, Nigeria faces a severe HIV and AIDS epidemic.

MEASURE Evaluation in Nigeria

MEASURE Evaluation began working in Nigeria in 2000 with a wide breadth of activities and a highly skilled in-country staff. “Nigeria is unique among MEASURE Evaluation’s country portfolios, because it has been among the largest portfolios in scope and has such diverse activities,” said Stephanie Mullen, MEASURE Evaluation’s Country Focal Person for Nigeria. “We work in a lot of different health areas, collaborating with several ministries and a variety of partners.”

Since 2008, MEASURE Evaluation has been providing assistance to activities addressing HIV and AIDS, orphans and vulnerable children, malaria and other infectious diseases, while working to build capacity and strengthen the country’s health information system, including the launch of innovative partnerships with Obafemi Awolowo and Ahmadu Bello universities.

Strengthening Information Systems and M&E Capacity

Building capacity within Nigeria to carry out monitoring and evaluation (M&E) activities is a critical step toward improving the country’s health system. “Monitoring and evaluation are at the center of sound service delivery, including HIV and AIDS-related care and support,” explained Oyediran. “They are necessary for the achievement of evidence-based policymaking, budget decisions, management and accountability.”

National Response Information Management System

In 2004, MEASURE Evaluation helped the Nigerian government develop and implement the Nigerian National Response Information Management System (NNRIMS). Since its implementation, MEASURE Evaluation has continued to help improve the reporting and use of data generated by the system throughout the country. In 2009, the project collaborated with the National Agency for AIDS Control (NACA) on an assessment of the NNRIMS system. “Data from the NNRIMS has helped government institutions and stakeholders in reporting and making informed decisions,” said Oyediran. “As a result of our technical assistance, NACA and NASCP [National AIDS and STIs Control Program], as well as several of the nation’s 36 states, are able to generate reliable, timely, and accurate information to improve the coordination of HIV and AIDS activities where, previously, no HIV-related reports were being generated.”

Since the launch of NNRIMS, MEASURE Evaluation has continued to assist Nigeria in improving the system. This assistance included helping the Nigerian government design the integration of NNRIMS and the National Health Management Information System (NHMIS), and contributing to a routine data quality assessment (RDQA) checklist and NHMIS Policy Review concept paper. 

Health Facilities Directory

In 2013, Nigeria’s Minister of Health launched a countrywide directory of health facilities developed by the Federal Ministry of Health’s Department of Planning Research and Statistics and MEASURE Evaluation. This directory of more than 34,000 health facilities is coded to indicate key information, such as location, facility type, and whether the facility is publicly or privately owned. The directory is set to be the backbone of the NHMIS. The information it provides is fundamental to the effective and efficient functioning of health management and service delivery in Nigeria, functions that require detailed and up-to-date information about the facility-based sources of health care.

District Health Information System

The Nigerian government recently adopted the District Health Information System 2.0 (DHIS 2.0) software as the means to capture HIV and AIDS data throughout the country. To ensure the smooth deployment of the software, at both national and local levels, MEASURE Evaluation has helped to draft the blueprint for implementation of the new software in Nigeria, developed a standardized DHIS 2.0 training curriculum, and provided mentoring and multi-day trainings on DHIS 2.0.

MEASURE Evaluation has also provided technical assistance to the National Joint Data Quality Assessment Exercise, an activity that assessed health facility- and community-based indicators, in 18 states.

M&E Training with Nigerian Universities

At the request of the Nigerian government and USAID/Nigeria, MEASURE Evaluation began an M&E institutional capacity building project. The purpose was to build the capacity of two premier Nigerian universities – Obafemi Awolowo University in the southern city of Ile-Ife, and Ahmadu Bello University in the northern city of Zaria – and help them become Nigeria's key M&E training and resource institutions. Following initial support and technical assistance, the institutions would be able to offer fee-based M&E workshops and continue offering workshops on their own – resulting in a sustainable, country-owned model for M&E training. In 2012, MEASURE Evaluation conducted a sustainability assessment of each institution that led to the development of sustainability plans. Key areas assessed include: governance, leadership, and people; financial sustainability; environment, and technical capacity. The report provides more information related to the assessment, including key findings and recommendations.

Data Demand and Use

A National HIV/AIDS M&E Assessment revealed weak usage of HIV and AIDS information among stakeholders in Nigeria, with insufficient compilation and reporting of high-quality data. In response, MEASURE Evaluation has collaborated with the National Agency for AIDS Control (NACA), the Department of Planning, Research and Statistics (DPRS), the National AIDS and STIs Control Program (NASCP), State Ministries of Control of AIDS (SACA), and the State Ministries of Health in Anambra, Kano and Lagos states, to implement a variety of Data Demand and Use (DDU) interventions, including:

  • Conducting High Impact Research workshops attended by members of government agencies, research institutions and universities,
  • Regular M&E Technical Working Group meetings,
  • Launch of the National HIV and AIDS Research Center (NHRC), which is housed in a library open to the public, with an operations manual to guide the design and implementation of a Data Demand and Use strategy in the HIV and AIDS sector; and
  • Onsite DDU coaching for health agency teams in the states of Anambra, Lagos, and Kano.

Orphaned and Vulnerable Children

Traditionally, efforts to care for children orphaned and made vulnerable by HIV and AIDS in Nigeria were carried out by extended family members with support from community and religious groups. Over time, though, the HIV and AIDS response heightened government awareness of the needs of orphans and vulnerable children (OVC). As a result, the government assumed a leading role in the provision of a standardized care and support system for the children.

Working with the Federal Ministry of Women Affairs and Social Development

MEASURE Evaluation assists OVC stakeholders, most notably Nigeria’s Federal Ministry of Women Affairs and Social Development (FMWASD), to strengthen their capacity to collect, analyze and use strategic information for OVC programs and to develop a functional M&E system for the national Orphans and Vulnerable Children response. Trainings focus on MEASURE Evaluation tools and approaches, such as Data Demand and Use, routine data quality assessment (RDQA) and the Child Status Index tool.

MEASURE Evaluation played a key role in helping draft the original National Plan of Action for Orphans and Vulnerable Children, collaborating closely with the Federal Ministry of Women Affairs and Social Development, the U.S. government, UNICEF, the National Technical Coordinating Group on OVC, and others, to agree on strategic objectives and indicators. MEASURE Evaluation has coordinated revisions for the updated National Plan of Action for OVC (2013–2020) and has helped the Federal Ministry of Women Affairs and Social Development to harmonize and implement a national OVC M&E plan. Implementing the national M&E plan includes training M&E staff in the use of the National OVC Management Information System (NOMIS) – an electronic database for reporting data on orphans and vulnerable children.

National Situational Analysis and Assessment for OVC

In 2008, MEASURE Evaluation supported the Nigerian government in conducting the National Situational Analysis and Assessment (SAA) for orphans and vulnerable children. The assessment reported that 17.5 million children fall into this category in Nigeria, and the findings were vital for planning and implementing future OVC programs. To help fill information gaps and make further programmatic and policy decisions for the Orphans and Vulnerable Children response, MEASURE Evaluation completed several secondary analyses that used data from the Situational Analysis and Assessment.

Measuring the Impact of Health Education

Nigeria’s Community Partnership for Action in the Social Sectors (COMPASS) project was a four-year endeavor to improve health education among women and children. The COMPASS integrated reproductive/child health and primary school education interventions in 51 local government areas in the states of Bauchi, Kano, Lagos and Nasarawa, as well as the Federal Capital Territory – all areas with high infant and child mortality rates and low levels of primary schooling, especially for girls. 

MEASURE Evaluation collaborated with the Center for Research Evaluation and Resource Development to carry out baseline and midline surveys to evaluate the COMPASS project, and also assisted with a later end-line survey. The end-line survey combined a large-scale household survey with surveys of health facilities and public and private primary schools in the five states. Findings from the end-line survey were compared to findings from the previous surveys to document changes in indicators as a way to measure the project’s impact.

Prevention of Mother-to-Child Transmission

Preventing the transmission of HIV from mother to child is a major priority in Nigeria, where only a small percentage of babies born to mothers with HIV receive treatment. PEPFAR has bolstered the Nigerian government’s effort to escalate coverage and effectiveness of Prevention of Mother-to-Child Transmission (PMTCT) initiatives. MEASURE Evaluation is helping the National HIV Division of Nigeria’s Ministry of Health to improve data collection and quality, enhance information sharing, and develop the skills of providers in the Prevention of Mother-to-Child Transmission realm. Selected PMTCT activities include:

  • A review of PMTCT data collection and reporting tools, based on the harmonized Operational Plan for the Nigerian National Response Information Management System.
  • Development of user guides for PMTCT tools;
  • Technical support to produce the Universal Access Report, which has several key PMTCT indicators; and
  • Baseline data quality assessments in the three pilot states of Anambra, Kano and Oyo. Findings from the data quality assessments are being used to create and implement PMTCT capacity-building plans in each state. Read more about the assessments.

Assessment of Primary Health Care Facilities for Decentralization of HIV and AIDS Services

Increasing coverage and access to HIV and AIDS services has been a central focus of Nigeria’s 2010 -2016 HIV and AIDS National Strategic Framework. Key stakeholders are collaborating with the National Agency for the Control of AIDS (NACA) and other government agencies to implement the activities outlined in the framework, including an assessment of the readiness of primary healthcare facilities to provide services. Between August and December 2012, MEASURE Evaluation implemented the assessment in 17 states and Federal Capital Territory (FCT). These assessment data, from 268 primary health facilities, provided systematic evidence on the readiness of decentralized institutions to deliver HIV services, particularly antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT).

The findings suggested striking differences in the service delivery environment among the states and within the facilities assessed in each state. Although most of the assessed facilities were observed to be functioning and providing a range of health services, including HIV services, assessment findings indicated a need to strengthen systems to support the quality of services. Quality improvements are needed in areas such as pharmaceutical storage, standard precautions to prevent infection, record maintenance, written service guidelines and adherence to established standards, and use of data. Findings from the assessment and 18 profiles highlighting the status of each facility are being used in planning ART and PMTCT scale-up activities.

Malaria Post-Bednet Study

In May and June 2009, Malaria Consortium distributed more than 4 million long-lasting insecticidal- treated nets (LLINs) in Kano State, to pilot the free bednet distribution recommended by the Nigeria National Malaria Control Program and the Roll Back Malaria initiative. The ultimate goal was universal coverage—one net for two people—in Nigeria by 2015.

In order to assess the campaign strategy, MEASURE Evaluation partnered with USAID/Nigeria, Support to Nigeria Malaria Program and Research Marketing Services to conduct a comprehensive post-campaign household survey in Kano State. The survey found that the campaign was effective in increasing bednet coverage, but better distribution and more education through a wider variety of outreach methods were needed.

The final report, published in 2010, serves as a reference document to improve the scaling up of the free distribution campaign strategy. MEASURE Evaluation worked closely with a Kenya-based technology firm to document and archive the survey data so that they are publicly available and accessible to other researchers.

In February 2012, Malaria Journal published, “Can universal insecticide-treated net campaigns achieve equity in coverage and use? The case of northern Nigeria,” a paper by MEASURE Evaluation staff exploring equity in mosquito net use. MEASURE Evaluation has also conducted further analysis to examine differentials in mosquito net usage based on gender.

Improving State-Level Information Systems

In 2011 MEASURE Evaluation began working at the state level in Kano, Lagos and Anambra. Each of these states has its own advisor who sits in the State Agency for the Control of AIDS and works collaboratively with the State Ministry of Health to improve the state health information system, especially for HIV and AIDS. “When working only at the national level, it can be hard to tell how much information gets down to the lower levels, so this is a nice opportunity,” noted Stephanie Mullen.

MEASURE Evaluation has designed its support around findings from baseline assessments conducted in each state using the 12 Components Monitoring and Evaluation Systems Strengthening Tool, with the eventual goal of presenting Kano, Lagos and Anambra as model states for the rest of the country. Examples of activities include:

  • Data Quality Audit (DQA) trainings for key staff in each state,
  • Support to state-level M&E staff through quarterly supervision visits and Data Quality Audits, in facilities and local government agencies in each state,
  • Continuous on-the-job training and mentorship, with an emphasis on integrating basic M&E concepts,
  • Formal M&E training through Ahmed Bello and Obafemi Awolowo universities, and
  • Technical assistance to government agencies in developing state-level HIV research agendas.

Geographical Information Systems Mapping Summit

Geographic information systems (GIS) offer enormous potential for furthering understanding of public health and improving health outcomes. However, in Nigeria the Federal Ministry of Health has for years operated without access to the data necessary for these approaches. MEASURE Evaluation helped organize the country’s first Health and Mapping Summit to address this gap.

The 2011 Nigeria Health and Mapping Summit: Enlisting National Mapping Agencies in Improving Health Outcomes brought together 120 participants including Members of Parliament, program managers, leaders from local and international non-governmental organizations and donor agencies such as USAID, the World Health Organization and the World Bank. Together, they worked to increase the Federal Ministry of Health’s involvement in Nigeria’s national geo-spatial data infrastructure (NGDI) program, and to share data – especially health-related data – among sectors.

In 2013, MEASURE Evaluation provided a GIS training focusing on Quantum GIS to improve capacity in Nigeria for using GIS in health applications. Workshop participants came from the Federal Ministry of Health and Social Work’s National Primary Health Care Development Agency, World Health Organization, USAID-funded Targeted Sates for High Impact Practices (TSHIP) project, and the Expanded Social Marketing Project in Nigeria (ESMPIN) project. MEASURE Evaluation has followed this training with state-targeted GIS trainings for the state ministries of health staff in the states of Bauchi and Sokoto.