Creating the foundation for health system resilience in Northern Nigeria

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Study Justification:
– The study focuses on a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in Northern Nigeria.
– It highlights the use of a Complex Adaptive System (CAS) approach to strengthen the health system and improve resilience.
– The study addresses the challenges of weak governance, limited management capability, and the impact of the Boko Haram insurgency.
Study Highlights:
– The CAS approach identified critical leverage points in social and professional systems to improve health service delivery.
– Significant improvements were achieved in the RMNCH continuum of care.
– The study laid the foundation for the implementation of Primary Health Care Under One Roof, a national strategy for strengthening health sector governance and services.
Study Recommendations:
– Implement a CAS approach to health system strengthening in other regions and countries.
– Prioritize governance, finance, institutional management, community systems support, access and accountability, and service delivery.
– Learn from the experience in Northern Nigeria to strengthen health systems during emergencies and conflict situations.
Key Role Players:
– Nigerian professionals from various disciplines.
– Donors and funding agencies.
– Government officials and policymakers.
– Health system managers and administrators.
– Community leaders and representatives.
Cost Items for Planning Recommendations:
– Funding for training and capacity building of health professionals.
– Resources for improving governance and accountability mechanisms.
– Investments in infrastructure and equipment for health facilities.
– Support for community engagement and participation.
– Monitoring and evaluation systems to track progress and outcomes.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The abstract provides a description of a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in Northern Nigeria and how it utilized a Complex Adaptive System (CAS) approach to strengthen the health system and improve resilience. The abstract mentions the program’s work with various determinants of the health system, its achievements in health service delivery, and the establishment of a national strategy. However, the abstract lacks specific quantitative data or statistical analysis to support the claims made. To improve the strength of the evidence, the authors could include more specific results, data, and analysis to demonstrate the impact of the program and its approach.

—The experience of a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in four states of Northern Nigeria illustrates how a Complex Adaptive System (CAS) approach to health system strengthening can lead to health systems becoming more resilient. The program worked with the array of political, cultural and social determinants which interact to shape the health system and its functionality. It worked in an environment marked by weak governance with little public accountability and by very limited management capability in inadequately regulated markets. To these conditions of fragility was added the shock from the rapidly deteriorating security situation caused in 2011 by the Boko Haram insurgency and the government’s ensuing response. A CAS theory of change provided the basis for the multi-faceted approach that identified critical points of leverage among institutions in social as well as professional systems and helped achieve significant improvements in health service delivery in the RMNCH continuum of care. It also established the foundation for Primary Health Care Under One Roof, which has emerged as a central national strategy in Nigeria for strengthening health sector governance and services under the 2014 Health Act. This article draws on the experience of work undertaken in Northern Nigeria over the course of the last 10 years. A team largely of Nigerian professionals from an array of disciplines worked widely across the health system, addressing issues of governance, finance, institutional management, community systems support, access and accountability, and service delivery—frequently at the same time. This experience provides lessons for efforts elsewhere on how to strengthen health systems during and after emergencies (such as Ebola in West Africa) and in situations affected by conflict.

Based on the provided description, it is difficult to identify specific innovations for improving access to maternal health. However, some potential recommendations based on the context of the article could include:

1. Strengthening governance and accountability: Implementing measures to improve governance and increase public accountability in the health system, which can help ensure effective management and resource allocation for maternal health services.

2. Enhancing management capability: Investing in training and capacity-building programs to improve the management skills of healthcare professionals, enabling them to effectively oversee and coordinate maternal health services.

3. Regulating markets: Implementing regulations and standards to ensure the quality and safety of maternal health services provided by private healthcare providers, particularly in inadequately regulated markets.

4. Addressing social determinants: Recognizing and addressing the social determinants that impact maternal health, such as cultural practices, gender inequalities, and socioeconomic factors, to ensure equitable access to care.

5. Leveraging institutions: Identifying critical points of leverage within social and professional systems to improve health service delivery, such as strengthening partnerships between healthcare facilities, community organizations, and government agencies.

6. Strengthening primary healthcare: Supporting the implementation of Primary Health Care Under One Roof, a national strategy in Nigeria for strengthening health sector governance and services, which can improve access to maternal health services at the primary care level.

7. Learning from emergency situations: Drawing lessons from experiences in Northern Nigeria, as well as other emergency situations like the Ebola outbreak in West Africa, to develop strategies for strengthening health systems during and after emergencies and conflicts.

These recommendations are based on the information provided and may need to be further tailored to the specific context and needs of the maternal health system in Northern Nigeria.
AI Innovations Description
The recommendation to improve access to maternal health based on the description provided is to adopt a Complex Adaptive System (CAS) approach to health system strengthening. This approach recognizes the interconnectedness of various factors that shape the health system and its functionality, including political, cultural, and social determinants.

By working with these determinants, the health system can become more resilient and better equipped to address challenges. This approach was successfully implemented in a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in Northern Nigeria, which faced weak governance, limited management capability, and a deteriorating security situation.

The CAS approach identified critical points of leverage among institutions in social and professional systems, leading to significant improvements in health service delivery in the RMNCH continuum of care. It also laid the foundation for the implementation of Primary Health Care Under One Roof, a national strategy in Nigeria for strengthening health sector governance and services.

Lessons from this experience can be applied to other contexts, including emergencies like the Ebola outbreak in West Africa and situations affected by conflict. By addressing issues of governance, finance, institutional management, community systems support, access, and accountability, health systems can be strengthened and maternal health access can be improved.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile health clinics: Implementing mobile health clinics that can reach remote areas and provide essential maternal health services, including prenatal care, vaccinations, and postnatal care.

2. Telemedicine: Utilizing telemedicine technology to connect pregnant women in remote areas with healthcare professionals, allowing them to receive virtual consultations, guidance, and monitoring.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, educate women on pregnancy and childbirth, and facilitate referrals to healthcare facilities when necessary.

4. Maternal health vouchers: Introducing a voucher system that provides financial assistance to pregnant women, enabling them to access quality maternal health services at healthcare facilities.

5. Maternal waiting homes: Establishing maternal waiting homes near healthcare facilities to accommodate pregnant women who live far away, ensuring they have a safe place to stay before giving birth and reducing the risk of complications during transportation.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather data on the current state of maternal health access, including the number of healthcare facilities, their locations, and the population distribution in the target area.

2. Modeling: Develop a simulation model that incorporates the potential recommendations and their expected impact on improving access to maternal health. This model should consider factors such as distance to healthcare facilities, population density, and the effectiveness of each recommendation.

3. Scenario testing: Simulate different scenarios by adjusting variables in the model, such as the number of mobile health clinics or the coverage of telemedicine services. Evaluate the impact of each scenario on improving access to maternal health, considering factors like increased service utilization, reduced travel time, and improved health outcomes.

4. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model by varying key parameters and evaluating the resulting impact on access to maternal health. This helps identify the most influential factors and potential limitations of the recommendations.

5. Policy recommendations: Based on the simulation results, provide policymakers with evidence-based recommendations on the most effective strategies to improve access to maternal health. Consider factors such as cost-effectiveness, scalability, and sustainability of the recommendations.

By following this methodology, stakeholders can gain insights into the potential impact of different innovations and make informed decisions to improve access to maternal health.

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