NURHI Phase 1 (2009 – 2015)
Phase 1 of NURHI was implemented in six cities (Federal Capital Territory, Ibadan, Ilorin, Kaduna, Benin and Zaria). According to the 2013 Nigeria Demographic and Health Survey, it contributed to significant increases in contraceptive prevalence in these cities.
Through Research, Monitoring and Evaluation (RM&E), NURHI 2 tracked and rapidly assessed program performance against output and outcome indicators. NURHI 2 used this information to periodically review each project component; better understand what worked and why; refine implementation approaches and activities; and inform decision making throughout the project.
NURHI 2 Data Sources
NURHI 2 generated real-time data through innovative, technology-driven, and cost-effective data sources. The types of data generated varied during each of three programmatic phases: Formative/Start-up, Implementation, and Evaluation.
Figure 1: NURHI 2 Research, Monitoring and Evaluation Approach
NURHI 2 RM&E Approach
During 2015 and 2016, NURHI conducted landscaping analyses of family planning in Kaduna and Lagos States. These analyses drew from existing data sources as well as new surveys and assessments to guide design of intervention strategies and approaches. Figure 2 summarizes NURHI 2 formative/start-up data sources.
Figure 2: NURHI 2 Formative/start-up elements
Secondary Analysis of Available Data
NURHI conducted a secondary analysis of the 2013 Nigeria Demographic and Health Survey for each of the three States prior to implementation to gain deeper understanding of:
Performance Improvement Assessments:
NURHI 2 conducted needs assessments in selected high-volume sites and project designated facilities prior to implementation of performance improvement interventions. An assessment tool which evaluated gaps in infrastructure, staffing strength and competencies in providing a variety of family planning methods was used. NURHI 2 used findings to develop performance improvement plans that guided facility-specific interventions.
Baseline Health Facility Surveys
Facility surveys generated information about the quality of family planning services at high volume sites and their readiness to provide integrated family planning services. Surveys looked at client perceptions of family planning services as well as the gaps and needs of service providers to offer high quality family planning services. Surveys were comprised of three components: a facility audit, provider interviews, and client exit interviews.
Baseline population level cross-sectional surveys (the flexi-track omnibus surveys)
To track the reach and effects of NURHI 2 demand generation campaigns, NURHI 2 conducted population level surveys in each of the three states every six months. These studies, conducted by a commercial market research company, provided timely data that monitored progress and indicated the need for mid-course corrections.
NURHI 2 RM&E Approach
During this phase, NURHI 2 used research, monitoring and evaluation to monitor progress and guide modifications to plans; and worked with the States to strengthen their monitoring and evaluation capacity.
Technical Assistance for State Monitoring and Evaluation
NURHI 2 worked with each of the three States to strengthen their health and family planning monitoring and evaluation systems. This simultaneously improved the quality and use of data by the States while improving the quality and reliability of data used by NURHI 2 to monitor and evaluate its interventions. NURHI 2 supported this process through three key interventions: developing State plans of action, supporting data quality assurance exercises, and introducing data review and feedback meetings.
1. Developing plans of action for data use and quality improvement
NURHI 2 engaged the States’ Monitoring and Evaluation and Health Monitoring Information Systems (HMIS) units to assess their monitoring and evaluation priorities, challenges and barriers. This included an analysis of HMIS data flow. Based on these analyses, each State created a plan of action to improve data quality and use.
2. Supporting State-led quarterly data quality assurance exercises
NURHI 2 supported State teams to implement integrated quality assurance exercises on a quarterly basis.
3. Introducing quarterly data review and feedback meetings
To ensure that providers and stakeholders within the family planning space had access to updated information on a quarterly basis, NURHI 2 supported states to organized quarterly data review meetings.
NURHI 2 Programme Management Information System
NURHI 2 used routine systems and surveys to monitor and track its service delivery, demand generation and advocacy strategies at national and State levels. NURHI 2 teams in each of the States routinely tracked program activities and used monitoring and evaluation data to adjust interventions. Click here to view the NURHI 2 Mid-term Learning Evaluation Highlights
1. Midterm (mid-program) health facility survey
NURHI 2 conducted a midterm health facility survey in the three States to monitor facility level indicators. The project reviewed and used findings from this survey to make mid-term course corrections.
2. Population-based Flexi-track Omnibus Surveys
NURHI 2 employed advocacy, community mobilization and media campaigns to influence family planning norms. To monitor the reach and assess the effects of these efforts, NURHI 2 contracted a commercial research firm to conduct population level cross-sectional surveys in the three project states every six months.
NURHI 2 collected data on service utilization, referrals and stock-outs in all high-volume sites (HVS) in the three States each month. To the extent possible, the project used data captured through the Health Management Information System (HMIS). NURHI 2 also designed, tested and coached health facility staff at HVS to use a mobile phone-based data reporting system to track data not captured through the HMIS. The project disaggregated data by age to monitor the number of young persons aged 15-24 years receiving family planning services.
Learning and Sharing (Abstracts, Oral Presentation and Posters)
NURHI 2 shared data during program and data review meetings, and through briefs, infographics, publications and presentations. During the last few years of the project, the team presented over 150 oral presentations and posters for international and national conferences and meetings. NURHI 2 fostered learning through quarterly State-led feedback meetings with service providers, State Ministry of Health teams, and other stakeholders. Feedback meetings served as a platform for sharing data, challenges and emerging issues.
NURHI 2 RM&E Approach
Endline Evaluation Phase
During this phase, NURHI 2 collected and analyzed data from multiple sources to measure programme and population level outcomes associated with project implementation. The project used both secondary and primary data sources to measure and document key outcomes.
End-line Facility Survey
Final evalution survey measuring service delivery outcome indicators Eg. percent of service providers who report approval of service provision without bias, percent of women who would return to their provider and refer a friend or family member, etc.
End-line Household Survey
Final evalutions measuring population level outcomes, and impact indicators Eg. contraceptive prevalence rate, percent of women who have heard religious leaders speak about family planning, percent of women who believe that most of their peers are using family planning, etc.
Secondary Analysis and need-based Adhoc Surveys
Ad hoc surveys were done without any plan for repetition. They were mostly operations research implemented as needed Eg. study of effects of interpersonal communication and counseling on quality of care, study to explore the reasons for a sudden increase in failure rates of long acting reversible contraceptives.