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.
Empirical evidence from a NURHI 2 facility baseline study showed that providers’ beliefs and perceptions often prompted them to restrict access to family planning services based on the client’s age, marital status, parity and partner’s consent. NURHI 2 employed a multi-prong approach to tackle provider bias.
Service Provider Training
The project provided training to improve technical competence and adherence to medical guidelines and protocols. All trainings included sessions on interpersonal communication and counselling and values clarification aimed at addressing provider bias.
Interpersonal Communication and Counseling (IPCC)
NURHI 2 also provided three-day stand alone IPCC trainings for doctors, Nurses/Midwives and Community Health Extension Workers. IPCC training was also incorporated into various trainings such as the Fresh FP Training for Physicians and Nurses/Midwives (4 weeks), IPCC and Injectable Training for CHEWs (5 days), LARC Refresher Training (5 days) and FP Interpersonal Communication and Counselling Skills Training for non-clinical providers (3 days).
Whole Site Orientations
NURHI 2 visited health facilities and oriented all facility staff including non-healthcare workers on correct FP information and dispelling myths and misconceptions. This provided a platform to address biases among both clinical and non-clinical staff working within the facility, ensuring that all clients visiting the facility receives correct and unbiased information about FP services regardless of the cadre of staff they encounter.
Supportive Supervision and On-the-Job Training
Supportive supervision helps to identify, and address capacity gaps including provider biases; strengthens service delivery; and provides mentorship/coaching. NURHI 2 also employed this approach to ensure competency and proficiency, improve performance and jointly solve systemic problems. Capacity gaps identified during supervisory visits were highlighted for focus during On-the-Job training for CHEWs and Nurses/Midwives.
Human Centred Design Approaches to Address Provider Bias
NURHI 2 adopted a Human Centered Design (HCD) approach to identify underlying problems associated with provider-bias with a view to developing new prototype solutions. HCD is an approach to creating products, services, and systems that place the end-users – the people the design is meant to help – at the centre of the entire design process. The outcome of applying the approach gave birth to two main interventions: Client-Provider Dialogue and Modified Values Clarification… Read More
With this interaction and feedback process, sharing of correct information is improved and opportunities are created for service providers to hear directly from clients such that pertinent issues that result from their biases are addressed using national protocols and guidelines….. Read More
The National Family Planning Training Manual includes a values clarification exercise that has been used in the same manner over the years, yet provider bias persists. The session was not sufficient to address providers’ bias. Developed by service providers during a human centred design process, the NURHI 2 modified values clarification exercise challenges providers to explore the reasons behind their beliefs, and also reflect on the consequences of their actions when clients are denied FP methods. The session is designed to be held during any formal gathering or meeting...Read More
NURHI 2 developed the DLE platform to reinforce family planning skills post-training. The tool is intended to supplement training and supportive supervision. The DLE platform shares short videos that can be shown on mobile phones, demonstrating supportive and unsupportive provider behaviors when providing services to clients. It also allows service providers to self-assess and participate in lessons designed to address common challenges encountered during FP service delivery, such as managing side effects, addressing misconceptions, adhering to clinical protocols, and maintaining adequate contraceptive supplies…Read More