Nigeria Evidence-based Health System Initiative (NEHSI) / Initiative Données probantes et systèmes de santé au Nigeria (NEHSI)

Permanent URI for this collection



Nigeria Evidence-based Health System Initiative (NEHSI)

Nigeria has some of the highest infant, child, and maternal death rates in the world. Greater access to primary health care can reduce deaths through prevention and early treatment. Timely and accurate information can guide decisions on what services should be provided and where resources can be allocated. But when evidence is missing and capacities are limited, it is difficult to make informed decisions that result in effective, efficient, and equitable health systems and positive health outcomes.

The Government of Nigeria, Foreign Affairs, Trade and Development Canada, and IDRC have partnered to meet this challenge. Through the Nigeria Evidence-based Health System Initiative (NEHSI), support to primary healthcare reforms in two Nigerian states are strengthening health information systems, improving the health of mothers and children, and building a culture of evidence-based health planning.

Learn more about the Nigeria Evidence-based Health System Initiative (NEHSI)



Gouvernance pour l’équité dans les systèmes de santé (NEHSI)

Au Nigeria, les taux de mortalité des mères, des enfants et des nouveau-nés sont parmi les plus élevés au monde. Or, un meilleur accès aux soins de santé primaires (SSP) peut réduire le nombre de décès grâce à la prévention et à un traitement rapide. Une information exacte et à jour permet d’orienter les décisions en ce qui concerne les services à offrir et l’affectation des ressources. Mais quand les données probantes font défaut et les capacités sont limitées, il est difficile de prendre des décisions éclairées donnant lieu à des systèmes de santé efficaces, efficients et équitables et à une amélioration de la santé.

Le gouvernement du Nigeria, Affaires étrangères, Commerce et Développement Canada et le CRDI ont établi un partenariat afin de remédier à ce problème. Par le truchement de l’initiative Données probantes et systèmes de santé au Nigeria (NEHSI), ce partenariat appuie des réformes des soins de santé primaires qui, dans deux États du Nigeria, permettent de consolider les systèmes d’information sur la santé, d’améliorer la santé des mères et des enfants et de créer une culture de planification fondée sur des données probantes.

En savour plus sur l'initiative Données probantes et systèmes de santé au Nigeria (NEHSI)



Browse

Recent Submissions

Now showing 1 - 16 of 16
  • Item
    Proof of influence evaluation of the Nigeria evidence‐based health system initiative (NEHSI)
    (2014-07-15) Wilson-Grau, Ricardo; Macfarlane, Sarah; Lecky, Muhammed
    The goal of this Proof of Influence evaluation is to harvest the outcomes of the project; it provides background and context for the project, objectives, and theory of change. The Nigeria Evidence‐based Health System Initiative (NEHSI) undertook activities to increase the generation and use of evidence for decision-making in Bauchi and Cross River states, in order to strengthen the health care system towards delivering effective, efficient and equitable primary health care (PHC). This evaluation reviews outcomes, relevance, and NEHSI’s contribution with NEHSI stakeholders. The pattern of outcomes at the community and individual levels was distinctly different from that at the institutional level.
  • Item
    Harnessing the power of technology to strengthen health systems in Nigeria : insights from the Nigeria Evidence-based Health System Initiative
    (Nigeria Evidence-based Health System Initiative (NEHSI), IDRC, Ottawa, ON, CA, 2014) IDRC. Nigeria Evidence-based Health System Initiative (NEHSI)
    To address the issue of maternal deaths, a community surveillance system was piloted in Giade (a Local Government Area of Bauchi State). Once the foundation was built, Community Health Extension Workers (CHEWs) were trained in electronic data collection. Tablets connected to the server send a signal back to the CHEW upon data entry, facilitating referrals for cases requiring follow-up. From regular visits, CHEWs combined data collection and real-time health referrals, sharing information with households about risk factors. In the Nigeria Evidence-based Health System Initiative (NEHSI) technologies were embedded in other initiatives designed to reinforce the health system, with powerful results.
  • Item
    Culture de planification fondée sur des données probantes : processus adopté pour la mise en oeuvre de l'initiative NEHSI; démarche de l'initiative Données probantes et systèmes de santé au Nigeria (initiative NEHSI) dans les États de Bauchi et de Cross River
    (Initiative Données probantes et systèmes de santé au Nigeria (NEHSI), CRDI, Ottawa, ON, CA, 2014-07) CRDI. Initiative Données probantes et systèmes de santé au Nigeria (NEHSI)
  • Item
    Building a culture of evidence-based planning : a process document; the Nigeria Evidence-based Health System Initiative (NEHSI) approach in Bauchi and Cross River States
    (Nigeria Evidence-based Health System Initiative (NEHSI), IDRC, Ottawa, ON, CA, 2014-07) IDRC. Nigeria Evidence-based Health System Initiative (NEHSI)
    This paper expands information on the 6 year process and implementation of a successful e-health initiative (to 2014). As the National Health Information System policy is revised, aspects of the Nigeria Evidence-based Health System Initiative (NEHSI) approach are being integrated into policy, especially the social audit and community surveillance system. The NEHSI project clearly demonstrates that strengthening the health information system contributes to strengthening the entire health system. This document explains how the planning phase contributed to the design, and provides an overview of key NEHSI principles.
  • Item
    Information is an intervention that works : results from the Nigeria Evidence-based Health System Initiative (NEHSI) in Bauchi and Cross River States (2008 – 2014)
    (Nigeria Evidence-based Health System Initiative (NEHSI), IDRC, Ottawa, ON, CA, 2014) IDRC. Nigeria Evidence-based Health System Initiative (NEHSI)
    Improving the health of women and children worldwide is central to development. In Nigeria, ground-breaking research that addresses the root causes of maternal, child, and newborn mortality demonstrated that producing and sharing good-quality information with target communities and decision makers, combined with bringing health care to households, reduces the maternal and infant mortality ratios. NEHSI is a collaboration between the Government of Nigeria, Foreign Affairs, Trade and Development Canada, and Canada’s International Development Research Centre (IDRC) in Bauchi and Cross River states. NEHSI strengthened health systems through the entry point of health information systems.
  • Item
    OpenHDS : Open-source Health and Demographic Surveillance System
    (INDEPTH Network, 2011) OpenHDS Community
    Health Management Information Systems (HMIS) are clinic-focused and largely blind to community events; but Health and Demographic Surveillance Systems (HDSS) have potential to provide reliable denominator values and track HMIS indicators with greater accuracy. The presentation outlines a model for an integrated health information and monitoring system in Nigeria.
  • Item
    OpenHDS (Health and Demographics System) : about
    (OpenHDS, 2013) OpenHDS
    For one billion people living in the world’s poorest countries, where the burden of disease is highest, those who are born or who die are still not counted. OpenHDS is a system that can maintain a consistent record of significant demographic events that occur to a population in a fixed geographic region, generate up-to-date registration books, and compute basic demographic rates (births/age, deaths, etc). OpenHDS also provides a mobile component where data entry can be performed while in the field. OpenHDS was created as an open source health and demographics system for developing countries where demographic data is in short supply.
  • Item
    Configuring the OpenHDS Mobile Application
    (Google Project Hosting, 2013)
    This guide explains the required steps to get up and running with the mobile application for OpenHDS (Health and Demographics System) application. After a baseline census is completed, the study population is established and various regions and locations are defined. This application allows the entire study population to be downloaded onto a mobile device. The OpenHDS Mobile application solves key issues where the id's of particular entities and various other fields can be automatically filled and thus error rates can potentially be significantly reduced. OpenHDS was created as an open source health and demographics system for developing countries.
  • Item
    Integrating mobile collection software with health applications
    (Institute of Electrical and Electronics Engineers (IEEE), 2011) Roberge, David; MacLeod, Bruce; Hartsock, Brian; Asangansi, Ime
    This paper describes and analyzes three approaches for integrating mobile data collection software and health applications. The first approach uses a domain-specific language module that is installed in a health application that communicates directly with the mobile data collection software. The second approach uses Mirth Connect to integrate the mobile collection software with a health application. The third approach is writing custom code required to integrate mobile data collection software with a health application. In the final section of this paper, we provide an analysis of the three approaches, and make recommendations on which approach should be used based on the resources available to a health facility.
  • Item
    Community counts : a participatory approach to social audits
    (BioMed Central, 2011) Hausmann-Muela, Susanna
    Community matters – community responds. Yet many health planners still consider people as passive recipients of programs. Social audits respond to the voice of different stakeholders, including intended beneficiaries, in order to improve health planning and service delivery. The introductory and concluding papers of a special supplement to BioMed Central, discusses the evolution of Centro de Investigación de Enfermedades Tropicales (CIET)’s social audit methods, the lessons learned, and the way forward to the next generation of social audits.
  • Item
    Population weighted raster maps can communicate findings of social audits : examples from three continents
    (BioMed Central, 2011) Mitchell, Steven; Cockcroft, Anne; Andersson, Neil
    Background: Maps can portray trends, patterns, and spatial differences that might be overlooked in tabular data and are now widely used in health research. Little has been reported about the process of using maps to communicate epidemiological findings. Method: Population weighted raster maps show colour changes over the study area. Similar to the rasters of barometric pressure in a weather map, data are the health occurrence – a peak on the map represents a higher value of the indicator in question. The population relevance of each sentinel site, as determined in the stratified last stage random sample, combines with geography (inverse-distance weighting) to provide a populationweighted extension of each colour. This transforms the map to show population space rather than simply geographic space. Results: Maps allowed discussion of strategies to reduce violence against women in a context of political sensitivity about quoting summary indicator figures. Time-series maps showed planners how experiences of health services had deteriorated despite a reform programme; where in a country HIV risk behaviours were improving; and how knowledge of an economic development programme quickly fell off across a region. Change maps highlighted where indicators were improving and where they were deteriorating. Maps of potential impact of interventions, based on multivariate modelling, displayed how partial and full implementation of programmes could improve outcomes across a country. Scale depends on context. To support local planning, district maps or local government authority maps of health indicators were more useful than national maps; but multinational maps of outcomes were more useful for regional institutions. Mapping was useful to illustrate in which districts enrolment in religious schools – a rare occurrence - was more prevalent. Conclusions: Population weighted raster maps can present social audit findings in an accessible and compelling way, increasing the use of evidence by planners with limited numeracy skills or little time to look at evidence. Maps complement epidemiological analysis, but they are not a substitute. Much less do they substitute for rigorous epidemiological designs, like randomised controlled trials.
  • Item
    Social audit strengthens primary care and health information systems : a method fact sheet of the Nigeria Evidence-based Health System Initiative (NEHSI)
    (CIET, 2013) CIET
    Social audits help to pinpoint actionable factors affecting the health of mothers and their children and facilitate discussions with communities, service workers and planners. The bulletin explains the steps of a social audit including interviews with thousands of people, and how through cycles of data collection, analysis, community feedback and interpretation, followed by socializing evidence for participatory action, social audits make sense of health challenges in light of available resources and government priorities. The Nigeria Evidence-based Health System Initiative (NEHSI) is a collaborative project between Nigeria and Canada, to support a fair, effective, and efficient primary healthcare system.
  • Item
    Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states
    (2011) Andersson, Neil; Omer, Khalid; Caldwell, Dawn; Dambam, Mohammed Musa; Maikudi, Ahmed Yahya
    Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. Method: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering. Findings: The most consistent and prominent of 28 candidate risk factors and underlying determinants for nonfatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5). Interpretation: Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives – genital mutilation, domestic violence, and steep power gradients – is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women’s fear of husbands or partners and not discussing pregnancy are all within men’s capacity to change.
  • Item
    Proof of impact and pipeline planning: directions and challenges for social audit in the health sector
    (2011) Andersson, Neil
    Social audits are typically observational studies, combining qualitative and quantitative uptake of evidence with consultative interpretation of results. This often falters on issues of causality because their cross-sectional design limits interpretation of time relations and separation out of other indirect associations. Social audits drawing on methods of randomised controlled cluster trials (RCCT) allow more certainty about causality. Randomisation means that exposure occurs independently of all events that precede it – it converts potential confounders and other covariates into random differences. In 2008, CIET social audits introduced randomisation of the knowledge translation component with subsequent measurement of impact in the changes introduced. This “proof of impact” generates an additional layer of evidence in a cost-effective way, providing implementation-ready solutions for planners. Pipeline planning is a social audit that incorporates stepped wedge RCCTs. From a listing of districts/communities as a sampling frame, individual entities (communities, towns, districts) are randomly assigned to waves of intervention. Measurement of the impact takes advantage of the delay occasioned by the reality that there are insufficient resources to implement everywhere at the same time. The impact in the first wave contrasts with the second wave, which in turn contrasts with a third wave, and so on until all have received the intervention. Provided care is taken to achieve reasonable balance in the random allocation of communities, towns or districts to the waves, the resulting analysis can be straightforward. Where there is sufficient management interest in and commitment to evidence, pipeline planning can be integrated in the roll-out of programmes where real time information can improve the pipeline. Not all interventions can be randomly allocated, however, and random differences can still distort measurement. Other issues include contamination of the subsequent waves, ambiguity of indicators, “participant effects” that result from lack of blinding and lack of placebos, ethics and, not least important, the skills to do pipeline planning correctly.
  • Item
    Software extensibility strategies for health and demographic systems in low-income countries
    (2011) Hartsock, Brian; MacLeod, Bruce; Roberge, David; Asangansi, Ime
    Software systems used by health research centers in low-income countries typically need to be maintained and upgraded by individuals who do not have formal Computer Science education. Without careful planning, these data management software systems can require years of technical assistance from highly trained specialists. This work proposes software design strategies to minimize the complexity of maintaining a Java based enterprise scale software application in low-income countries. In this paper we identify various extension mechanisms. The goal is to significantly reduce the complexity required for users to tailor the system to their own particular projects.