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Beyond Technical Solutions: Critical Pathway in the Political Economy of Health Development in Northern Nigeria

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Author

Affiliation

PRRINN-MNCH (Sokpo); Health Partners International (Mecaskey)

Date
Summary

This presentation outlines the goals and strategies of a Nigerian programme seeking to create behaviour change around maternal and child health using a political economy approach. Specifically, it explores a joint programme between: (i) the Partnership for Reviving Routine Immunization in Northern Nigeria (PRRINN), funded by United Kingdom's Department for International Development (DFID) from 2006-13 in response to the global resurgence of polio, and (ii) Maternal Newborn and Child Health (MNCH), funded by the State Department of the Norwegian Government from 2008-13.

Several opening slides provide background as to the situation related to infant and maternal mortality in Northern Nigeria, including failures that have motivated PRRINN-MNCH. Areas of focus include:

  • Output 1: Strengthened State and Local Government Area governance of Primary Health Care (PHC) system
  • Output 2: Improved human resource policies and practices for PHC
  • Output 3: Improved delivery of Routine Immunisation (RI) and Maternal Newborn & Child Health (MNCH) services via the PHC system
  • Output 4: Operational research providing evidence for PHC stewardship, policy and planning, service delivery, and effective demand creation
  • Output 5: Improved information generation with knowledge being used in policy and practice
  • Output 6: Increased demand for RI and MNCH services
  • Output 7: Improved capacity of Federal Ministry level to enable States' MNCH and RI activities.

The political economy assessment that is integrated into this process has several communication elements, such as: identify issues which, in a general sense, appear to provide good opportunities for creating coalitions of interest and for levering desired institutional changes.

To illustrate these points, a case study is provided: the Gunduma approach. Stakeholder engagement and local ownership were pivotal, which included building a supportive environment by, for example, conducting cross-state peer reviews among health policymakers and managers. Amongst the results: The Gunduma Health System Board has been established by law. From 2007/8-2009 (among a population of 750,000), there was:

  • An increase in RI coverage from 40% to 65%.
  • A reduction in diphtheria, pertussis (whooping cough), and tetanus (DPT) dropout rate from 34% to 11%.
  • An increase in women attending an antenatal clinic (ANC) from 25,240 to 44,710.
  • An increase in facilities offering ANC from 39 to 45.

In conclusion, the authors note that the health system is a social institution; health sector reform is profoundly political. Key to achieving change is addressing the social and political as well technocratic context to make meaningful progress toward universal coverage and the Millennium Development Goals (MDGs). However, multifaceted engagement strategies make for difficult-to-specify inferential models, pointing to the need for situation-specific assessment and engagement.

Click here to view the entire presentation on Slideshare.

Source

The Crossing blog, accessed May 24 2012.