1) The document summarizes a project in Northern Nigeria aimed at improving maternal and child health outcomes through strengthening the health system and increasing immunization rates.
2) The project, called PRRINN-MNCH, was funded by the UK and Norway and worked with state governments to establish human resources units, cost essential health services, and boost community engagement to increase service utilization.
3) Early results showed immunization rates doubled and increased four-fold where community engagement occurred, though starting from a low base. Maternal and child health also saw discernible progress, but the author notes reconciling global goals with local interests and engaging all levels of society were still a work in progress.
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Beyond Scaling Up: PRRINN in Nigeria
1. TAKING INNOVATION TO SCALE IN NORTHERN NIGERIABeyond Technical Solutions: Reconciling Global Goals and Local Interests Jeffrey W. Mecaskey, FFPH Managing Director Beyond Scaling Up: Pathways to Universal Access Institute for Development Studies 24-25 May 2010
2. OVERVIEW Northern Nigeria The project & its supporters Project aims Project approaches Theories of change Local aims Beyond technical solutions
3. Recent history Fulani Jihad (1806-10) British Indirect Rule (1899-1906) Colonial rule from 1914 & 1960 Political Islam--2000 Global recrudescence of polio—Kano cessation of vaccination—2004 NORTHERN NIGERIA—I
4. Partnership for Reviving Routine Immunization in Northern Nigeria funded by UK DfID from 2006 New Labour “challenge” to US-driven vertical approach of “national immunisation days” PRRINN
5. Meanwhile, beyond immunisation…….. MALARIA! Putatively higher maternal mortality ratio, perhaps ~1,500 versus national average of ~600. Putatively higher neonatal and infant mortality rates Generally accepted notion of poorly governed, poorly developed public sector institutions NORTHERN NIGERIA—II
6. Maternal Newborn and Child Health Initiative funded by State Department of the Norwegian Government funds from 2008 Norway’s Jen Stoltenberg, with Tore Godal, led Global Business Plan for MDG’s 4 & 5 In the context of the IHP+ Global Compact on application of the Paris Principles of Harmonization MNCH
7. Discernable progress toward MDGs 4 &5 Public administration practice Shift to knowledge culture Health system functionality Health service utilisation Movement toward universal coverage PRRINN-MNCH I: AIMS
8. Governance & system strengthening Human resources Service delivery Operations research HMIS strengthening & knowledge management Demand creation PRRINN-MNCH II: PROGRAMME OF WORK
9. THEORIES OF CHANGE Rational actors theory Dempster–Shafer or evidence-belief theory Principal-agent theory Political economy theory Public policy in the public interest Demonstration (evidence) will support (belief) ergo change Recognising asymmetry of information & aligning differentiated interest Identifying power-economic interests & leveraging them for aspired change
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11. RECONCILING GLOBAL GOALS WITH LOCAL INTERESTS MDG remain paradigm for programme Development of the mechanics of health system necessary, but not sufficient Evidence-accountability continuum remains normative with hope of ∆ to positive Engagement strategy, and a bit of luck, contributing to early discernable change Complexity means, with optimism, the future is uncertain
12. TAKE AWAY MESSAGES The health system is a social institution—more than the aggregation of technical inputs Health sector reform entail significant re-location of resource so is profoundly political Multifaceted engagement strategies make for difficult to specify inferential models Nevertheless, it would seem that political and social engagement, in addition to technocratic engagement, provide a prospect for meaningful change
13. This work would not have been possible without the generous support of the United Kingdom’s Department for International Development and the Government of Norway’s Department of State This synthesis/summary is based on the extraordinary work of the PRRINN-MNCH Team, led by Drs.GarbaIdris & Rodion Kraus On behalf of the Team, I am grateful to the risk taking and foresight of our Northern Nigerian Drivers of Change working at community, facility and state levels Any errors are my own and any opinions reflect my own view, and not necessarily those of the Governments of Nigeria, Norway or the United Kingdom or project management Na Gode! Acknowledgements
Notas do Editor
What are the lessons from health and other sectors about how to facilitate rapid learning from existing successes and innovations and apply this learning in a scaled up way? What are the relative roles of public and private sectors and how do innovations spread across these sectors? What institutional arrangements are favourable for rapid spread of effective innovations? What are the roles of the state, professional and business associations and other bodies? What do we mean by sustainable scaling up?
