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What is the best way to save one million lives?

David Evans's picture

Last October, the Government of Nigeria committed to save one million lives by 2015 by increasing access to cost-effective health services and commodities, a bold goal.

Crucially, the Federal Ministry of Health is coupling the scale-up of services and commodities with a focus on knowledge, using rigorous impact evaluation strategically and systematically across their programs (in partnership with the World Bank’s Development Impact Evaluation Unit and the Gates Foundation).  Each evaluation adapts promising evidence from elsewhere in the world to fit the Nigerian context, letting the Government and its partners see which interventions are most effective in saving lives.

One upcoming impact evaluation focuses on pre-natal care and skilled birth attendance, comparing non-monetary and monetary incentives to keep midwives from dropping out of clinic service, based on evidence from health workers in Zambia and elsewhere that community recognition can be even more effective than cash.  It also offers a conditional cash transfer to encourage women to participate in pre-natal care, skilled birth, and post-natal care, which was found to be effective in a project in India.

And it incorporates community monitoring and reporting of drug shortages at birth centers to increase transparency, a variation of which as has been shown to improve health outcomes in Uganda

All three problems – midwife attrition, diversion of drugs, and insufficient utilization – were identified by the Federal Ministry of Health in an earlier, major midwife program.  Now the Ministry is addressing these problems using interventions that have worked elsewhere and testing their effectiveness in Nigeria.

A second evaluation will examine the use of midwives, nurses, and possibly community health workers to deliver antiretroviral drugs for the prevention of mother-to-child transmission of HIV/AIDS, as well as the involvement of private providers to deliver this crucial service.  A third will explore alternative distribution supply chains for essential medicines, as was proven effective in Zambia.

Beyond the Saving One Million Lives initiative, World Bank researchers are working with two Nigerian states to examine the effectiveness of community volunteers to promote malaria prevention and home treatment activities, using family groups to monitor their own relatives’ performance: Evidence from Nigeria and elsewhere suggests that home treatment by community workers can outperform treatment through the standard health system. The same study explores the impact of training small private drug vendors to accurately diagnose malaria and then sell the recommended medication, building on evidence of the effectiveness of a related intervention in Kenya

The Government is also working with the World Bank’s Results-Based Financing Initiative to evaluate results-based financing of health care (which had significant success in Rwanda) in three Nigerian states, based on the premise that health centers and hospitals will be more productive and responsive to population needs if their financing depends on the quality and quantity of care that they provide. Pilots are currently underway, and the project’s next expansion will incorporate a rigorous impact evaluation.

This model of identifying major priorities and problems with past interventions, and then using evidence of what has worked elsewhere and adapting and testing it locally, holds great potential. With this approach, and together with its development partners, Nigeria can save the next million lives even faster.

Photos by Curt Carnemark

 

Comments

Submitted by Pgeorge Anikoh on
Medical personnel often shy away from remote regions for obvious reasons of the absence of conducive work environments. The government spends huge amount of resources on providing health centres that mostly end up mere blue prints. Maybe deploying about 5000 mobile clinics to service about 10,000 of Nigeria's wards would help to change this phenomenon and make healthcare services more accessible.

Submitted by OLLAN on
The best solution to Nigeria problem is empowerment. If the Government can gainfully employ or empower the teeming youth, the issue of health and restlessness will be easily tackled. More so, there are people how are genuinely ready to venture into agriculture and manufacturing rather than merchandizing economic system.

Submitted by Diabetes Nigeria on
This is a laudable approach, and we hope it will work since it is evidence based. But Nigeria has a problem of poor execution of ideas and projects. We hope strategies are in place to avoid the problem and ensure the success of the program. We want to make a case for NCDs, which are already epidemics all over the world. Several data and evidence points to the fact that a rigorous and enhanced campaign, enlightenment is required to prevent several avoidable complications, including death, that could arise from these largely preventable conditions. Diabetes Nigeria is a not-for-profit diabetes group, a member of mHealth Alliance, dedicated to increased diabetes education, awareness, care and support for people with diabetes (PWD) in Nigeria through social media and on-ground campaigns.

Submitted by Joe Amon on
One way to save 1 million lives is for Nigeria's President to release the $4 million pledged to clean up villages in Zamfara where the worst lead poisoning epidemic in modern history has taken place. 400 children have died and 2,000 are at risk. What is the World Bank doing to address this?

Submitted by Nachiket Mor on
There is a lot to learn for us in India from this thoughtful approach taken by Nigeria towards the scaleup of its programmes. If any any case rollout has to be stage-wise (on account of implementation and financial constraints) why not make it randomised (it may even be more ethical to do so) and set up evaluations that "naturally" provide answers even as scale-up proceeds.

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