With a rapidly rising population of over 167 million, Nigeria remains in dire need of health systems reform and increased access to health care to meet the needs of its increasing population. Despite considerable gains in the past decade, Nigeria's reproductive health indicators are still very poor. Country-wide, the total fertility rate is 5.7 children per mother, with a contraceptive prevalence rate of less than 10 percent. Furthermore, these statistics mask wide regional variations—for example, the total fertility rate in the northwestern region is as high as 7.3, with a contraceptive prevalence rate of 3 percent. Additionally, HIV and AIDS remain grave problems for Nigeria. In 2011, it was estimated that 3.4 million Nigerians were living with the virus, the second highest national HIV burden in the world.
Much of Pathfinder's work today involves developing local institutional capacity to deliver and manage high-quality programs addressing reproductive health, family planning, maternal and child health, and HIV and AIDS. By developing institutional capacity, Pathfinder works to empower local communities in Nigeria to advocate for quality services. Well known throughout the country for its management of complex, multi-site projects, Pathfinder has strengthened the technical and training capacity of local partners and institutions to build sustainable, cost-effective, and culturally appropriate interventions.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting data that enables public, private, and community partners to make informed health-related decisions. In Nigeria, examples of the kinds of data we collect range from the "number of pregnant women with unknown HIV status who received HIV counseling and testing" and the "number of women given appropriate uterotonic in correct dose within 1 minute of delivery of baby" to the "number of monitoring and 'quality of care' visits to facilities by quality improvement teams." Some illustrative data from Pathfinder's projects in Nigeria include:
- 130,483 women delivered or sought postpartum services at project facilities
- 1,185 women were treated for postpartum hemorrhage using the non-pneumatic anti-shock garment (NASG) that Pathfinder introduced
- 28,358 individuals received care and treatment for HIV after receiving their HIV test results
Building Capacity, Strengthening Systems
Over the past three years, Pathfinder has built the organizational, institutional, and technical capacity of more than 50 local organizations that are implementing reproductive health, family planning, maternal and newborn care, and HIV and AIDS programs in Nigeria. Pathfinder's institutional capacity building initiatives strengthen the ability of local partners (including NGOs, public and private sector organizations, and the Ministry of Health) to develop, plan, implement, and monitor quality interventions. Pathfinder has developed trainings in strategic planning, proposal development, resource mobilization, financial and program management, and monitoring and evaluation to ensure that local partners are equipped to provide quality services. Pathfinder encourages and facilitates networking and sharing of experience among its partners, and has fostered exchanges within Nigeria and with organizations in other countries where we work.
For four years, Pathfinder has partnered with Ministry of Health at both the national level and in seven states to revise guidelines and job aides for the prevention and management of postpartum hemorrhage, the most common cause of maternal mortality in Nigeria. This involves the inclusion of two new technologies: active management of third stage of labor and the use of the non-pneumatic anti-shock garment. More than 900 health care providers were trained on these new guidelines across the country. Additionally, Pathfinder worked with the Nursing and Midwifery Council of Nigeria to integrate these new guidelines in the pre-service training curriculum of midwives. Pathfinder has also offered technical support to the Federal Ministry of Women Affairs to implement a Maternal Health Project aimed at reducing deaths due to eclampsia and postpartum hemorrhage, by training and mentoring master trainers on how to use the non-pneumatic anti-shock garment. Pathfinder has also been in the forefront of advocating the use and availability of misoprostol for the prevention and management of postpartum hemorrhage at the community level.
Pathfinder builds on its successful CCA-PPH Plus model to address the two leading causes of maternal mortality: postpartum hemorrhage and pre-eclampsia/eclampsia.
In Nigeria, Tanzania, and Uganda, Pathfinder aims to improve the capacity of community-based organizations to better prevent mother-to-child transmission of HIV.
The m4Change project was launched in 2012 to improve the quality of services provided by community health workers through the deployment of a mobile phone antenatal care application designed to facilitate more accurate decision making.
Funded by the MacArthur Foundation, this project works to reduce the morbidity and mortality associated with postpartum hemorrhage in India and Nigeria.
In this edition of Pathways, we share stories from clients served by in our maternal health projects, with a focus on prevention of mother-to-child transmission of HIV and postpartum hemorrhage.
Strengthening Community and Health Systems for Quality PMTCT: Applications in Kenya, Nigeria, South Africa, and Ethiopia
This technical brief discusses PMTCT implementation experience in four African countries, providing recommendations for future efforts to more holistically advance improved PMTCT outcomes in resource-limited settings.
The purpose of the Working Paper Series is to disseminate work in progress by Pathfinder International staff on critical issues of population, reproductive health, and development.
With the support of the MacArthur Foundation, since 2007 Pathfinder International has implemented the Continuum of Care: Addressing Postpartum Hemorrhage project to prevent and manage PPH in India and Nigeria.
Pathfinder International embarked on a project designed to help Nigeria get to that goal. It began equipping community health extension workers with CommCare, a mobile phone app that collects information needed to determine the kind of antenatal health services provided to mothers.