Service Delivery

Introduction

Phase 1 of the Nigerian Urban Reproductive Health Initiative (NURHI) contributed to an impressive 11.5% increase in modern contraceptive use among women of childbearing age over its five years of implementation (NURHI Endline Report, 2014). As a result, over 350,000 more families began using family planning methods. NURHI 2 aims at scaling up the proven interventions from NURHI 1 to replicate these results in other Nigerian states and eventually facilitate the institutionalisation of the NURHI 2 service delivery strategy into existing and new systems.


The NURHI 2 service delivery strategy focuses on improving the quality of and expanding equitable access to family planning services. Quality improvement in service delivery ensures that all women are provided with family planning services, including information. It also includes fostering an in-clinic environment that facilitates provision of high-quality family planning services, training providers in counselling and contraceptive provision and developing and disseminating tools that enhance the quality of service delivery. Expanded equitable access to family planning services through new and existing service channels involves removing barriers to accessing family planning services and proactively taking services to underserved communities. Details of these two interventions can be found in the NURHI 2 service delivery protocol.

Selection 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 include only public health facilities.

Quality Improvement

The NURHI 2 quality improvement strategy is an evidence-based, process-improvement approach aimed at identifying and bridging gaps by comparing standards with current realities. This strategy fosters client satisfaction and expands access to high-quality health care services.

Expanding Access to Family Planning Services

Expanding access in NURHI 2 focuses on using proven and new strategies to improve access to a wide range of modern contraceptive methods. The ultimate goal is to reach every woman in need to provide high-quality family planning services and a wide range of modern contraceptive options.

Tackling Provider Bias

Empirical evidence from a NURHI 2 facility baseline study showed that providers have beliefs and perceptions that prompt them to restrict access to family planning services based on the client's age, marital status, parity and partner's consent.

72-Hour Clinic Makeover

The NURHI 2 72-hour clinic makeover concept is one of its novel service delivery approaches. The environment in which family planning services are provided makes a difference in improving health care delivery for both the service provider and clients.

Service Delivery Job Aids

The Community Health Extension Workers booklet is a logbook that states the essential skills to be learned by these providers, including the required number of simulation and real-life experiences. It also provides space for the instructor to add a performance score and sign off when the learning exercise has been completed.


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