Selection of High-Volume Sites
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 include only public health facilities.
The facility selection criteria for NURHI 2 remains the same as NURHI 1, with one exception: Facilities clustered around the high-volume site that have smaller outpatient and clinic attendance and are not directly supported by the project were selected for outreach purposes and minor clinic renovations. The facility selection was done 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 Assessment and Performance Improvement Plan
To establish a baseline to measure progress and to inform performance improvement plans for family planning services, NURHI 2 instituted participatory facility assessments. As a first step, a performance improvement assessment tool was developed to measure quality indicators that the project intends to address at the various high-volume sites. These indicators were based on the National Performance Standards for Family Planning Services for Nigerian Hospitals, developed by the Federal Ministry of Health in 2009.
The 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. The questionnaires assessed issues such as hours of operation, personnel information in regard to cadres, 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, gaps were identified and key findings shared with relevant stakeholders, including the state Ministry of Health, local government areas and representatives of the health facilities. Specific interventions were developed to address these gaps.
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
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 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.
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.
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.
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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