by Maggie Dougherty
Northeast Nigeria isn’t known for being easy. It’s a complex environment: hot, dry and prone to droughts. Infrastructure is weak. Roads, hospitals, water systems and electricity simply don’t function throughout much of the state. The government health systems struggle to provide comprehensive care to citizens. These citizens aren’t engaged in holding institutions accountable, and often can’t access — or choose not to access — maternal and child health services. Boko Haram’s presence only complicates these challenges. Where do you start to create change and improve lives of mothers and children in a place like this?
The State Accountability and Quality Improvement Project (SAQIP), funded by the Bill and Melinda Gates Foundation and implemented by Pact, is starting by addressing both the government’s ability to provide services, and the people’s ability and willingness to access them. It’s an integrated approach that targets both the supply side (the government and health care providers) and the demand side (the people, particularly women). Local government authorities and primary health care facilities receive technical assistance through training, mentoring and coaching to improve their administration, management and oversight and data collection skills. SAQIP doesn’t simply help the government collect better data, it also builds the capacity of government employees to use that data to shape decision-making.
Additionally, SAQIP supports policy development. Pact is currently working with the State Ministry of Health and Primary Health Care Development Agency (SPHCDA) to define a set of health services that meet the priority health needs of the population at the least possible cost. This is the first step toward universal health coverage.
There’s a clinical element to SAQIP as well. Care providers are receiving capacity building on quality improvement methodologies and are currently testing ideas to improve the quality of health facilities across the state. These interventions are intended to enhance the continuum of care across antenatal, labor and postnatal care.
While improving the quality of service, SAQIP is simultaneously working with communities to increase their usage and understanding of the services provided. Pact partners with Ward Development Committees (WDCs) to ensure they’re aligned with national guidelines and works to develop new opportunities for women to participate in governance and activities.
At the community level, Pact establishes Mother’s Groups to reach some of the most vulnerable women and children and ensure they have the ability and the desire to access maternal and child health services. First, the project enables women to secure economic stability through Pact’s WORTH model so that women can access care for themselves and their children — with their own money. Second, SAQIP increases knowledge of maternal and child health so women want to access care. Women are empowered, but more importantly inspired, to take control of their health and the health of their children.
Suwaiba Musa joined one of these Mother’s Groups in her village. Suwaiba, 25, has been married for 10 years and has seven children. For most of her life, she couldn’t write. For most of her marriage, she relied on her husband to give her money to take sick children to the hospital. She didn’t have the skills to earn money on her own. She had few options to improve her situation – until the Mother’s Group.
She took out a loan of 5,000 naira (about US$16) and bought perfume and water packs to sell in her village, then used her profits to buy more goods to sell. She learned basic financial literacy and how to write her name. She learned about the importance of taking her children the hospital when they’re sick.
The health system in Gombe is being strengthened at multiple levels, from multiple angles. The health centers in Suwaiba’s community are receiving support to improve the quality of care. State agencies are increasing coordination and using data to make better decisions. Policies are being developed to better support mothers like Suwaiba. And Suwaiba is empowered: Her loans lead to profits. She’s an entrepreneur with an income, and she’s able to make decisions about her health and the health of her children.