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170,123,740 (July 2012 est.)
Population Growth Rate
2.553% (2012 est.)
43.9 % (0–14 years)
53.1% (15–64 years)
3 % (65 years and over)
13.48 deaths/1,000 population
Adult HIV Prevalence
3.70 % (2011 est.)
People Living with HIV
3,400,000 (2011 est.)
OTHER RELEVANT DATA
Infant Mortality Rate
88 infant deaths/1,000 live births (2010 est.)
Total Fertility Rate
5.5 children born/woman (2010 est.)
Maternal Mortality Ratio
550 maternal deaths/100,000 live births – 2006-2010 reported (2008 adjusted = 840/100,000)
With an estimated population of more than 170 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, 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 2010, the estimated infant mortality rate was 88 deaths per 1,000 live births, and approximately 14 percent of children die before the age of 5 (143 deaths per 1,000 live births.) And with an adult prevalence rate of 3.7 percent, Nigeria faces a severe HIV and AIDS epidemic.
MEASURE Evaluation in Nigeria
MEASURE Evaluation has been working in Nigeria since early 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), a routine HIV and AIDS information system. Since its implementation, MEASURE Evaluation has continued to help improve the reporting and use of the system throughout the country. In 2009, it collaborated with the National Agency for AIDS Control (NACA) to conduct an assessment of the 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 a few sub- national states are able to generate reliable, timely and accurate information to improve the coordination of HIV and AIDS activities in their states where, previously, no HIV-related reports were being generated.”
MEASURE Evaluation has also provided technical assistance to the National Joint Data Quality Assessment Exercise, which assessed health facility- and community-based indicators, in 18 states.
M&E Training with Nigerian Universities
In 2006, MEASURE Evaluation began conducting short-term M&E training courses in Nigeria with the goal of building capacity of local institutions to take over the trainings. In 2010, MEASURE Evaluation began a collaboration with two premier Nigerian universities – Obafemi Awolowo University in the southern city of Ile-Ife, and Ahmed Bello University in the northern city of Zaria – to institutionalize M&E pre-service and in-service training as part of the universities’ M&E curricula. The Departments of Community Health/Medicine and the Departments of Nursing at each school offer pre-service M&E courses, while in-service trainings include two-week workshops on M&E of Public Health. As of March 2013, fewer than two years after the collaboration launched, the universities have offered eight M&E workshops for approximately 200 participants. The success of these initiatives at Obafemi Awolowo and Ahmed Bello universities has led MEASURE Evaluation to begin the transition of full responsibility to the schools, so that they become the leading M&E training institutions in Nigeria.
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, and
- Launch of the National HIV and AIDS Research Center (NHRC), with an Operations Manual to guide design and implementation of Data Demand and Use strategy in the HIV and AIDS sector.
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 the government’s awareness of the needs of orphans and vulnerable children (OVC). As a result, the government began taking a lead 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 to 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 is coordinating revisions for the updated National Plan of Action for OVC (2013–2020) and helping 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
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. In order to fill in information gaps and make further programmatic and policy decisions for the Orphans and Vulnerable Children response, MEASURE Evaluation also undertook various secondary analyses on 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 of the country’s women and children. COMPASS integrated reproductive and 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 implement baseline and midline surveys to evaluate the COMPASS project and later assisted with an 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. Results from the end-line survey were compared to results from the previous surveys to document changes in indicators in order 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:
- Review of PMTCT data collection and reporting tools based on the harmonized Nigerian National Response Information Management Operational Plan;
- 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 are being used to create and implement PMTCT capacity-building plans in each state.
Assessment of Primary Health Care Facilities for Decentralization of HIV and AIDS Services
Increasing the coverage and access to HIV and AIDS services is 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, provide 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 suggest 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 quality 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. Results of the assessment and 18 profiles highlighting the status of each facility are being used by U.S. agencies in planning their 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.