TAKING INNOVATION TO SCALE IN NORTHERN NIGERIABeyond Technical Solutions:  Reconciling Global Goals and Local Interests<br...
OVERVIEW<br />Northern Nigeria<br />The project & its supporters<br />Project aims<br />Project approaches<br />Theories o...
Recent history<br />Fulani Jihad (1806-10)<br />British Indirect Rule (1899-1906)<br />Colonial rule from 1914 & 1960<br /...
Partnership for Reviving Routine Immunization in Northern Nigeria<br />funded by UK DfID from 2006<br />New Labour “challe...
Meanwhile, beyond immunisation……..<br />MALARIA!<br />Putatively higher maternal mortality ratio, perhaps ~1,500 versus na...
Maternal Newborn and Child Health Initiative funded by State Department of the Norwegian Government funds from 2008<br />N...
Discernable progress toward MDGs 4 &5<br />Public administration practice<br />Shift to knowledge culture<br />Health syst...
Governance & system strengthening<br />Human resources<br />Service delivery<br />Operations research<br />HMIS strengthen...
THEORIES OF CHANGE<br />Rational  actors theory<br />Dempster–Shafer or evidence-belief theory<br />Principal-agent theory...
Transparent budgetary administration:  in Zamfara state management of basket fund to EDP satisfaction<br />Political will:...
RECONCILING GLOBAL GOALS WITH LOCAL INTERESTS<br />MDG remain paradigm for programme<br />Development of the mechanics of ...
TAKE AWAY MESSAGES<br />The health system is a social institution—more than the aggregation of technical inputs<br />Healt...
This work would not have been possible without the generous support of the United Kingdom’s Department for International D...
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Beyond Scaling Up: PRRINN in Nigeria

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This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Mecaskey presented on PRRINN's experiences in Nigeria.

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Beyond Scaling Up: PRRINN in Nigeria

  1. 1. TAKING INNOVATION TO SCALE IN NORTHERN NIGERIABeyond Technical Solutions:  Reconciling Global Goals and Local Interests<br />Jeffrey W. Mecaskey, FFPH<br />Managing Director<br />Beyond Scaling Up: Pathways to Universal Access Institute for Development Studies<br />24-25 May 2010<br />
  2. 2. OVERVIEW<br />Northern Nigeria<br />The project & its supporters<br />Project aims<br />Project approaches<br />Theories of change<br />Local aims<br />Beyond technical solutions<br />
  3. 3. Recent history<br />Fulani Jihad (1806-10)<br />British Indirect Rule (1899-1906)<br />Colonial rule from 1914 & 1960<br />Political Islam--2000<br />Global recrudescence of polio—Kano cessation of vaccination—2004<br />NORTHERN NIGERIA—I <br />
  4. 4. Partnership for Reviving Routine Immunization in Northern Nigeria<br />funded by UK DfID from 2006<br />New Labour “challenge” to US-driven vertical approach of “national immunisation days”<br />PRRINN<br />
  5. 5. Meanwhile, beyond immunisation……..<br />MALARIA!<br />Putatively higher maternal mortality ratio, perhaps ~1,500 versus national average of ~600.<br />Putatively higher neonatal and infant mortality rates<br />Generally accepted notion of poorly governed, poorly developed public sector institutions<br />NORTHERN NIGERIA—II <br />
  6. 6. Maternal Newborn and Child Health Initiative funded by State Department of the Norwegian Government funds from 2008<br />Norway’s Jen Stoltenberg, with Tore Godal, led Global Business Plan for MDG’s 4 & 5<br />In the context of the IHP+ Global Compact on application of the Paris Principles of Harmonization<br />MNCH<br />
  7. 7. Discernable progress toward MDGs 4 &5<br />Public administration practice<br />Shift to knowledge culture<br />Health system functionality<br />Health service utilisation<br />Movement toward universal coverage<br />PRRINN-MNCH I: AIMS<br />
  8. 8. Governance & system strengthening<br />Human resources<br />Service delivery<br />Operations research<br />HMIS strengthening & knowledge management<br />Demand creation<br />PRRINN-MNCH II: PROGRAMME OF WORK<br />
  9. 9. THEORIES OF CHANGE<br />Rational actors theory<br />Dempster–Shafer or evidence-belief theory<br />Principal-agent theory<br />Political economy theory<br />Public policy in the public interest<br />Demonstration (evidence) will support (belief) ergo change<br />Recognising asymmetry of information & aligning differentiated interest<br />Identifying power-economic interests & leveraging them for aspired change<br />
  10. 10. Transparent budgetary administration: in Zamfara state management of basket fund to EDP satisfaction<br />Political will: formal expression of support by Governor of Jigawa<br />Technico-organisational developments:<br />Fulltime HR units established within each state & completing an HR audit<br />Posting of 96 new midwives per four state <br />Agreement on and costing of the Minimum Service Package in each state<br />Demand: <br />Increase in patient transfers for emergency obstetric care <br />Study on clustering of health problems suggests new approach needed to tackle vulnerable households where 20% women have 80% of deaths<br /><ul><li>Outcome: Doubling of routine immunisation rates for all the four states, increasing four fold where community engagement occurred, albeit from a very low base</li></ul>Early Results<br />
  11. 11. RECONCILING GLOBAL GOALS WITH LOCAL INTERESTS<br />MDG remain paradigm for programme<br />Development of the mechanics of health system necessary, but not sufficient<br />Evidence-accountability continuum remains normative with hope of ∆ to positive <br />Engagement strategy, and a bit of luck, contributing to early discernable change<br />Complexity means, with optimism, the future is uncertain<br />
  12. 12. TAKE AWAY MESSAGES<br />The health system is a social institution—more than the aggregation of technical inputs<br />Health sector reform entail significant re-location of resource so is profoundly political<br />Multifaceted engagement strategies make for difficult to specify inferential models<br />Nevertheless, it would seem that political and social engagement, in addition to technocratic engagement, provide a prospect for meaningful change<br />
  13. 13. This work would not have been possible without the generous support of the United Kingdom’s Department for International Development and the Government of Norway’s Department of State<br />This synthesis/summary is based on the extraordinary work of the PRRINN-MNCH Team, led by Drs.GarbaIdris & Rodion Kraus<br />On behalf of the Team, I am grateful to the risk taking and foresight of our Northern Nigerian Drivers of Change working at community, facility and state levels<br />Any errors are my own and any opinions reflect my own view, and not necessarily those of the Governments of Nigeria, Norway or the United Kingdom or project management<br />Na Gode!<br />Acknowledgements<br />

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