TCI Efforts Contribute to Niger State’s 130% Increase in Annual LARC Client Volume

Apr 13, 2020

Contributors: Olusola Solanke, Wale Adefila and Christabel Akinyode

Niger state has seen a 130% increase in LARC users and a 117% increase overall in annual client volume in its nine TCI-supported LGAs. (Source: HMIS)

In Niger state, Nigeria, the trend for long-acting reversible contraceptive (LARCs) acceptors in the nine local government areas (LGAs) supported by The Challenge Initiative (TCI) has risen 130% since TCI began implementation there in December 2017. This accounts for 15,338 more LARC users. Overall, TCI has contributed to 117% increase in annual client volume when comparing the 12-month period leading up to December 2019 with the 12-month period leading up to the baseline when implementation began in December 2017. With TCI technical coaching support, the Niger state government has been implementing a number of TCI proven approaches that has contributed to this increase. Niger state has truly embodied TCI’s “business unusual” approach, scaling up TCI’s proven approaches with its own financial resources in all 25 LGAs. As a result, these impressive trends underestimate TCI’s true impact beyond its demonstration LGAs and high-volume facility sites. The stories below showcase some of the proven approaches being diffused throughout the state.

Funding In-Reaches and Outreaches Across the State

Niger state believes that all its residents should have access to a minimum package of affordable and quality health services when and where needed, and with greater efficiency and cost effectiveness. This includes providing women of reproductive age access to information on child birth spacing and family planning services where they live or work to increase contraceptive uptake. The state organized family planning outreaches in communities to achieve this until TCI introduced Niger’s policymakers and other officials to family planning in-reaches – a TCI proven approach.

The TCI team supported government staff in writing proposals and memos to access funding to conduct a combination of outreaches and in-reaches across all 25 LGAs of the state – not just the nine supported by TCI. After persistent follow-up and continuous advocacy, funds for the activity were released in November 2019. TCI provided the state with technical assistance so it could most effectively organize, plan and implement in-reaches across the state.

The outreaches and in-reaches started from mid-November 2019 and lasted into the first week of December. The chart below shows, by method, a total of 15,405 people accessed services during in-reaches, while 3,518 persons accessed services during outreaches over that time period, with in-reaches providing almost five times more contraceptives.

Methods	IUD	Jadelle	Implanon	Depo	DMPA	Pills	Condom	Norist	Total
In-reaches	1296	2319	2878	1290	2802	2057	9222	1841	15405
Outreaches	10	5	17	193	16	107	3111	59	3518

After TCI’s demonstration of how an in-reach would look like during the MNCH week in February 2018, we saw that it was a cost-effective strategy with less spend compared to outreach, [and] it yielded more results. The results following the in-reaches and outreaches conducted in November through December 2019 emphasizes this fact; however, outreaches is still reserved for hard-to-reach communities.”

Dr. Hawa Tako Kolo

Director Community Health Services

Diffusion of Whole-Site Orientation and Quality Improvement Team Approaches

After witnessing improvements in the quality of service delivery at 40 TCI demonstration sites across the nine TCI-supported LGAs, Niger state adopted two more of TCI’s proven approaches – Whole Site Orientation and Quality Improvement Teams – and funded the scale up of these activities to cover an additional 80 high volume sites in the remaining non-TCI demonstration LGAs and one adolescent and youth sexual and reproductive health (AYSRH) demonstration LGA. Quality Improvement Teams (QIT) have been established in all 80 health facilities, and the teams are now meeting regularly to discuss quality issues. Whole-site orientation (WSO) sessions have also begun at each health facility. These interventions are aimed at engaging communities to drive quality improvement efforts of health facilities and reducing negative biases of healthcare workers towards clients intending to access family planning.

We adopted these interventions because we have seen the impact of WSO and QIT in addressing bias towards family planning and improving the quality of services provided by health care workers in TCI demonstration sites. Furthermore, the QIT does not only serve as a platform where the members of the community collaborate with service providers on healthcare delivery but also as a check on the quality of services provided by the healthcare workers. To that effect, the state thought it wise to scale up this proven-to-work intervention to other LGAs in the state.”

Dr. Ibrahim Dagana

Executive Director, Niger State Primary Healthcare Development Agency

Advocacy Efforts to Improve Data Quality at the LGA Level

Because of TCI’s advocacy efforts, the new Deputy Director of Health Planning Research and Statistics (DDHPRS) in the Niger State Primary Health Care Development Agency of the State Ministry of Health (SMOH), Mr. Kolo Salawu, has approved internet subscriptions for LGA monitoring and evaluation (M&E) officers to ensure more timely and reliable data is uploaded to the online health management information system (HMIS). Prior to this approval, the Niger state LGA M&E officers used implementing partner funding to access the internet to upload data to HMIS, which led some to prioritize indicators that were relevant to that particular implementing partner. In addition, data submissions were not done at regular intervals and quality was in question.

When Salawu became the DDHPRS, TCI’s State Program Coordinator briefed him on the importance of funding internet subscriptions for LGA M&E staff to ensure quality data for decision-making. Luckily funds for the internet subscription were already in the budget and could be easily drawn upon. Over the last four months, the state has provided N5,000 in stipends per LGA M&E officer across all 25 LGAs for a total of N125,000 (approximately $345), which has enabled LGA M&E officers to successfully upload the monthly summary data forms to the online HMIS. These funds have made the LGA M&E officers more accountable for improved data management, ensuring timely and complete upload of data. Monthly data uploads into the HMIS has increased across the state since the commencement of this support to the LGA M&E team.