The Challenge Initiative (TCI) recently published a case study in Global Health: Science and Practice examining how the Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool has been used by state governments in Nigeria as a innovative responsive feedback tool to assess progress toward self-reliance in implementing family planning and reproductive health programs.
RAISE is a facilitated tool used by state governments quarterly to track program improvements, identify gaps and provide feedback across four sustainability pillars: political and financial commitment, government capacity, institutionalization and sustained demand. The tool measures stages of capacity: beginning (54% and below), developing (55–69%), expanding (70–84%), and mature (85% and above). After self-administering the tool and scoring their progress, state governments develop a remediation plan with timelines and responsible persons assigned to address any challenges.
The article, published Feb. 28, 2023, examined 13 states supported by TCI (Ogun, Delta, Kano, Niger, Bauchi, Anambra, Plateau, Taraba, Abia, Rivers, Nasarawa, Lagos, and Gombe states) that completed five rounds of assessments between June 2020 and September 2022. Baseline results revealed that four states were at the developing stage, eight were at the expanding stage, and one had a mature program. The most recent assessment revealed mature capacity for nine states while the other four are in the expanding stage. Consequently, all states demonstrated improved government self-reliance over the course of the year.
The article identified the following five key responsive feedback elements that are incorporated into the RAISE tool:
- Requires diverse stakeholders to work together. The RAISE tool’s structured and participatory process allows state government teams across relevant departments to come together and self-assess their family planning/reproductive health program.
- Interrogates a program’s theory of change and makes assumptions explicit. TCI’s theory of change, which aims to increase modern contraception through government-led and government-driven programming, enabled the TCI team to use responsive feedback to identify areas of testing, which formed the domains captured in the RAISE tool.
- Prioritizes information gaps where a program would benefit from data and course correction. The RAISE tool enables government teams to track implementation progress, note gaps in service delivery, use data to corroborate findings collected, and make effective and evidence-informed decisions to improve their program.
- Seeks evidence to fill information gaps using learning questions. The tool makes provision for documenting evidence for findings reported, which enables the assessment teams to continue to update learning questions to interrogate the gaps and identify corrective measures for program improvement.
- Advocates pause-and-reflect sessions to evolve a program based on evidence. Following the RAISE assessment, the lead government facilitator convenes a feedback session in the form of a pause-and-reflect meeting, where relevant government staff and TCI reflect upon the findings and evidence and agree on action plans to improve programming.
The article concluded that RAISE assessment participants should use available government data sources to complement their RAISE assessment to ensure objectivity. Nevertheless, the tool contributed to state governments’ enhanced leadership and management of their family planning programs. The authors said:
The RAISE tool has proven to be a valuable responsive feedback tool, effectively contributing to the enhancement of Nigerian state governments’ leadership and management of their family planning/reproductive health programs. The approach is appreciated by state governments that are currently considering modifications to serve other integrated primary health care programs, such as malaria and nutrition.”
TCI will continue to monitor RAISE scores alongside health management information systems (HMIS) data across 21 supported states in Nigeria, including the 10 states that have graduated from direct TCI support, according to the authors.
This will enable TCI to track institutionalization of the tool, as well as its effectiveness in ensuring sustained program maturity and government capacity to implement the high-impact family planning and AYSRH interventions.”