Identification of High Volume Sites

In NURHI 1, a high-volume site was defined as a public or private health care facility serving the greatest number of maternal, newborn and child health clients (antenatal, delivery and immunisation clients) in the project cities. In NURHI 2, high volume sites included only public health facilities.

Facility selection criteria for NURHI 2 remained the same as NURHI 1. Facilities clustered around the high-volume site that had smaller outpatient and clinic attendance were selected for outreach services and minor clinic renovations. NURHI 2 selected high volume sites in collaboration with the State’s Ministry of Health.

A total of 194 high volume sites (primary and secondary health care facilities) were selected in the three implementation states: 73 in Kaduna State, 50 in Lagos State and 71 in Oyo State.

Performance Improvement Assessments and Performance Improvement Plans

NURHI 2 conducted participatory facility assessments to establish a baseline against which to measure progress and to inform performance improvement plans. As a first step, NURHI 2 developed a performance improvement assessment tool to assess quality indicators for family planning services. The project based these indicators on the National Performance Standards for Family Planning Services for Nigerian Hospitals, developed by the Federal Ministry of Health in 2009.

Facility assessments included structured facility observations and interviews with health facility staff, all of which were done in collaboration with the management team of the health care facility. Questionnaires assessed issues such as hours of operation, cadres of service providers, numbers and types of trainings received, service statistics, infrastructure, equipment, contraceptive stocks, record keeping and other services for integration of family planning. From the assessments, NURHI 2 identified gaps and shared key findings with representatives from the State Ministry of Health, Local Government Area and each health facility.