Determinants of effectiveness of a novel community health workers programme in improving maternal and child health in Nigeria
Lead Research Organisation:
University of Leeds
Department Name: School of Medicine
Abstract
Improved mother and child health (MCH) continues to be an issue of international priority, particularly for sub-Saharan African countries. Evidence suggests that schemes involving Community Health Worker (CHWs) can be effective in improving the health of mothers and children. Although such schemes are implemented in some developing countries such as Bangladesh, to guide further developments, much better understanding is needed on what makes CHW programmes successful and under what circumstances.
In Nigeria, despite significant improvements, mother and child health remains an issue of concern, particularly in rural areas where most vulnerable groups live. In 2012, the Federal Government of Nigeria established the Subsidy Reinvestment and Empowerment Programme (SURE-P) to invest the revenue from fuel subsidy reduction into a social security programme to improve lives of most vulnerable populations.
One SURE-P component, implemented in selected facilities in each State, focuses on maternal and child health (SURE-P/MCH). The idea is that recruitment of CHWs, combined with infrastructure development, and improved availability of supplies and medicines, will improve access to quality health services, and ultimately, improve mother and child health. Since December 2012, Conditional Cash Transfers (CCT) have also been added at selected sites ('SURE-P/MCH+CCT'). These incentive payments to pregnant mothers are linked to use of health services at different stages: e.g. for antenatal care visits and facility deliveries.
The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be achieved by investigating two implementations (i.e. with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will do so by:
1.Developing an in-depth understanding of the context and the process of implementation of the interventions, including relations between health workforce and infrastructure and supplies;
2.Identifying, assessing and comparing the intervention outputs (e.g. skills and practices of CHWs and efficiency of primary health care facilities) and outcomes (e.g. equitable access to quality MCH services and attainment of MCH outcome targets);
3.Developing an empirically-based and theoretically-grounded model of complex relations between the people involved, context, implementation process, outputs and outcomes of the interventions;
4.Developing transferable best practices for scalability (expansion within a broadly similar context) and generalizability (expansion to different contexts) of the interventions.
This five-year research and development project will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, which were selected in consultation with the Federal MOH and SURE-P national programme officer. Selecting two states from different parts of the country will provide an opportunity for different contextual factors that affect the implementation and outcome from the programme to be better elucidated and ensure that the findings are generalisable to the entire country. Within each State we will select three Local Government Areas (LGAs) clusters: one with SURE-P/MCH, one with SURE-P/MCH+CCT and one with no intervention. In each State the two interventions will be assessed against each other and against the comparison (i.e. no implementation) site.
We will work closely with local, State and Federal policymakers and practitioners, to generate answers that can be used to inform their policy decisions. We expect that better understanding of performance of the CHW programme in Nigeria will inform further strengthening of the existing programme, its replication within Nigeria, and other similar countries considering the implementation of CHW initiatives.
In Nigeria, despite significant improvements, mother and child health remains an issue of concern, particularly in rural areas where most vulnerable groups live. In 2012, the Federal Government of Nigeria established the Subsidy Reinvestment and Empowerment Programme (SURE-P) to invest the revenue from fuel subsidy reduction into a social security programme to improve lives of most vulnerable populations.
One SURE-P component, implemented in selected facilities in each State, focuses on maternal and child health (SURE-P/MCH). The idea is that recruitment of CHWs, combined with infrastructure development, and improved availability of supplies and medicines, will improve access to quality health services, and ultimately, improve mother and child health. Since December 2012, Conditional Cash Transfers (CCT) have also been added at selected sites ('SURE-P/MCH+CCT'). These incentive payments to pregnant mothers are linked to use of health services at different stages: e.g. for antenatal care visits and facility deliveries.
The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be achieved by investigating two implementations (i.e. with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will do so by:
1.Developing an in-depth understanding of the context and the process of implementation of the interventions, including relations between health workforce and infrastructure and supplies;
2.Identifying, assessing and comparing the intervention outputs (e.g. skills and practices of CHWs and efficiency of primary health care facilities) and outcomes (e.g. equitable access to quality MCH services and attainment of MCH outcome targets);
3.Developing an empirically-based and theoretically-grounded model of complex relations between the people involved, context, implementation process, outputs and outcomes of the interventions;
4.Developing transferable best practices for scalability (expansion within a broadly similar context) and generalizability (expansion to different contexts) of the interventions.
This five-year research and development project will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, which were selected in consultation with the Federal MOH and SURE-P national programme officer. Selecting two states from different parts of the country will provide an opportunity for different contextual factors that affect the implementation and outcome from the programme to be better elucidated and ensure that the findings are generalisable to the entire country. Within each State we will select three Local Government Areas (LGAs) clusters: one with SURE-P/MCH, one with SURE-P/MCH+CCT and one with no intervention. In each State the two interventions will be assessed against each other and against the comparison (i.e. no implementation) site.
We will work closely with local, State and Federal policymakers and practitioners, to generate answers that can be used to inform their policy decisions. We expect that better understanding of performance of the CHW programme in Nigeria will inform further strengthening of the existing programme, its replication within Nigeria, and other similar countries considering the implementation of CHW initiatives.
Technical Summary
The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be done by investigating two implementations (with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will:
1. Understand of the context and the process of implementation of the interventions;
2. Identify, assess and compare the intervention outputs and outcomes;
3. Develop a model of complex relations between the actors, context, implementation process, outputs and outcomes of the interventions;
4. Develop transferable best practices for scalability and generalizability of the interventions.
This five-year study will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, identified in consultation with the Federal MOH and SUREP national programme officer. The project is designed as a multi-disciplinary and mixed methods study, using qualitative and quantitative methods. Realist evaluation will be an overall platform for the study, which will use economic evaluation, social sciences and statistical analysis.
Qualitative data will be collected using in-depth interviews with facility managers, community health workers, PHC staff; facility exit interviews and focus group discussions with service users and their families. Quantitative data will include existing data from HMIS and SURE-P programme and structured facility exit survey with pregnant women. Analysis of quantitative and qualitative datasets will be integrated, to allow in-depth exploration of emerging issues and continuous triangulation of findings.
Project results will be disseminated widely through development of policy briefs, presentations at management meetings, newsletters and press-releases, to ensure their uptake in policy and practice in Nigeria and wider.
1. Understand of the context and the process of implementation of the interventions;
2. Identify, assess and compare the intervention outputs and outcomes;
3. Develop a model of complex relations between the actors, context, implementation process, outputs and outcomes of the interventions;
4. Develop transferable best practices for scalability and generalizability of the interventions.
This five-year study will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, identified in consultation with the Federal MOH and SUREP national programme officer. The project is designed as a multi-disciplinary and mixed methods study, using qualitative and quantitative methods. Realist evaluation will be an overall platform for the study, which will use economic evaluation, social sciences and statistical analysis.
Qualitative data will be collected using in-depth interviews with facility managers, community health workers, PHC staff; facility exit interviews and focus group discussions with service users and their families. Quantitative data will include existing data from HMIS and SURE-P programme and structured facility exit survey with pregnant women. Analysis of quantitative and qualitative datasets will be integrated, to allow in-depth exploration of emerging issues and continuous triangulation of findings.
Project results will be disseminated widely through development of policy briefs, presentations at management meetings, newsletters and press-releases, to ensure their uptake in policy and practice in Nigeria and wider.
Planned Impact
We expect our research to have a positive impact on Nigeria and internationally, due to:
a. development of expertise in how to advise policy-makers on the development and implementation of context-specific health and social policies
b. utilisation of an innovative cross-disciplinary approach to assess the effectiveness of a complex intervention
c. capacity strengthening and use of an innovative research approach in a highly influential African country
d. scientific advancement of theories on how to strengthen health systems and improve maternal and child services and health outcomes within the context of developing countries with relatively high and inequitable mortality and morbidity
The main beneficiaries are:
a. Policy-makers and implementers at the local, State, Federal, African and global levels responsible for the development and implementation of maternal and child health (MCH) and Community Health Worker (CHW) policies and Conditional Cash Transfer programmes
b. Nigerian public and private MCH service providers and practitioners
c. Local, national and international civil society organisations and user associations with interest in advocacy and provision of MCH services and beyond
d. National and international academia interested in MCH, health systems and policy research
e. Local, national and international media with a focus on health and social issues.
The economic and societal impact will be generated through the following benefits:
1) Improved policymaking:
Nigerian national and state policymakers will be provided with clear evidence of effectiveness of the two SURE-P components within two States, which will enable them to make informed decisions about the future implementation of these two programme components.
The comparative analysis will equip Nigerian State and Federal policy-makers with understanding of what works for whom and under what circumstances, to allow strengthening the SURE-P and developing accompanying legislation at different levels.
2) Improved policy implementation and service delivery:
Nigerian policy-implementers and practitioners at different levels will improve their understanding of how to enhance the effectiveness, efficiency and performance of MCH services and practices, improve the use of community health workers (CHWs) and adapt the implementation of the conditional cash transfer scheme.
The research will inform the need, and possible paths, for a change in culture and practices within health facilities to improve the quality of MCH services and changes in community practices related to MCH.
The research results will increase public awareness in Nigeria, and other similar countries, on how to strengthen the provision of MCH services and improve maternal and child health status. This information is likely to be taken up by local, national and international civil society organisations, user associations and media groups.
The results will inform social and private service providers in Nigeria on how to contribute effectively and efficiently to the provision of MCH services.
3) Improved health systems:
The research will inform the implementation for CHWs in Nigeria and other low and middle income countries (e.g. enhancement of the training curriculum and supervision and support required to CHWs).
International and national policymakers will be able to use the evidence for health systems strengthening through evidence-informed policies on MCH and an improved understanding of the context-dependency of health and social policymaking and implementation.
4) Improved health outcomes:
Nigerian women and children in general and specifically groups with compounded effects of vulnerability (such as poverty, education, region, religion and ethnicity) will benefit due to improved awareness and participation in the research and findings how to improve their health and well-being considering their specific circumstances.
a. development of expertise in how to advise policy-makers on the development and implementation of context-specific health and social policies
b. utilisation of an innovative cross-disciplinary approach to assess the effectiveness of a complex intervention
c. capacity strengthening and use of an innovative research approach in a highly influential African country
d. scientific advancement of theories on how to strengthen health systems and improve maternal and child services and health outcomes within the context of developing countries with relatively high and inequitable mortality and morbidity
The main beneficiaries are:
a. Policy-makers and implementers at the local, State, Federal, African and global levels responsible for the development and implementation of maternal and child health (MCH) and Community Health Worker (CHW) policies and Conditional Cash Transfer programmes
b. Nigerian public and private MCH service providers and practitioners
c. Local, national and international civil society organisations and user associations with interest in advocacy and provision of MCH services and beyond
d. National and international academia interested in MCH, health systems and policy research
e. Local, national and international media with a focus on health and social issues.
The economic and societal impact will be generated through the following benefits:
1) Improved policymaking:
Nigerian national and state policymakers will be provided with clear evidence of effectiveness of the two SURE-P components within two States, which will enable them to make informed decisions about the future implementation of these two programme components.
The comparative analysis will equip Nigerian State and Federal policy-makers with understanding of what works for whom and under what circumstances, to allow strengthening the SURE-P and developing accompanying legislation at different levels.
2) Improved policy implementation and service delivery:
Nigerian policy-implementers and practitioners at different levels will improve their understanding of how to enhance the effectiveness, efficiency and performance of MCH services and practices, improve the use of community health workers (CHWs) and adapt the implementation of the conditional cash transfer scheme.
The research will inform the need, and possible paths, for a change in culture and practices within health facilities to improve the quality of MCH services and changes in community practices related to MCH.
The research results will increase public awareness in Nigeria, and other similar countries, on how to strengthen the provision of MCH services and improve maternal and child health status. This information is likely to be taken up by local, national and international civil society organisations, user associations and media groups.
The results will inform social and private service providers in Nigeria on how to contribute effectively and efficiently to the provision of MCH services.
3) Improved health systems:
The research will inform the implementation for CHWs in Nigeria and other low and middle income countries (e.g. enhancement of the training curriculum and supervision and support required to CHWs).
International and national policymakers will be able to use the evidence for health systems strengthening through evidence-informed policies on MCH and an improved understanding of the context-dependency of health and social policymaking and implementation.
4) Improved health outcomes:
Nigerian women and children in general and specifically groups with compounded effects of vulnerability (such as poverty, education, region, religion and ethnicity) will benefit due to improved awareness and participation in the research and findings how to improve their health and well-being considering their specific circumstances.
Publications
Ebenso B
(2019)
Dealing with context in logic model development: Reflections from a realist evaluation of a community health worker programme in Nigeria.
in Evaluation and program planning
Etiaba E
(2020)
"If you are on duty, you may be afraid to come out to attend to a person": fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.
in BMC health services research
Ezumah N
(2022)
Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria
in Social Science & Medicine
Manzano A
(2022)
Conducting focus groups in realist evaluation.
in Evaluation (London, England : 1995)
Mbachu C
(2022)
Village health worker motivation for better performance in a maternal and child health programme in Nigeria: A realist evaluation.
in Journal of health services research & policy
| Title | Webinar: Introduction to Theory-Driven Evaluation and Realist Evaluation for Health Systems Researchers |
| Description | We developed and implemented two 90-minute webinars introducing health systems researchers to the concept of Realist Evaluation and the application of Realist Methodology for evaluating health systems interventions in low and middle income countries. A total of 13 researchers from Nigeria and the the United Kingdom participated remotely in the webinar, which enhanced their capacity (knowledge and skills) in this topic. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2016 |
| Impact | Attendees at webinar can now use realist approach for the data collection and analysis. |
| URL | https://www.dropbox.com/home/Webinars_REVAMP |
| Title | What makes a successful maternal and child health (MCH) programme |
| Description | This video explains the successes of the REVAMP project - improvements in maternal and child health - which ran in collaboration between the University of Leeds, University of Nigeria Enugu Campus and the Anambra State Ministry of Health. This project was supported by a grant from the Joint Health Systems Research Initiative. For further information please visit: http://bit.ly/REVAMPproject |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2020 |
| Impact | This video has sparked lots of interest in researchers around the globe about using animations to report research findings |
| URL | https://www.youtube.com/watch?v=dec5WEj6gb4&feature=youtu.be |
| Description | Sustainability of effects achieved by Governmental programmes for which funding is subsequently withdrawn, such as improved utilisation of healthcare, is often subject to invisible components of health systems such as patient-provider trust or sense of security in the provision and utilisation of healthcare services. The motivation of healthcare staff is determined by financial and non-financial incentives, and motivation works through different mechanisms such as feelings of public responsibility for the provision of healthcare to the population. On-going advocacy and lobbying efforts at national and sub-national levels are instrumental for maintaining the political prioritisation of the maternal and child health in the country. Realist evaluations are time-consuming though important ways of generating in-depth insights into the functioning of complex health programmes and generating implications of relevance to policy and practice. |
| Exploitation Route | Although it is difficult to quantify the longer-term impact at this stage, seven policy briefs developed from the project have already informed series of discussions and workshops on improving policy and practice in relation to maternal and child healthcare programmes at the State and Federal levels in Nigeria. Multiple academic publications advance theoretical and empirical knowledge on application of realist evaluations, role of trust, advocacy, health facility security, quality of data from health information systems and costs and cost-effectiveness of national health programmes. We anticipate that outputs from the study will contribute to further improvements of similar programmes and the methodological experience of conducing Realist Evaluation itself will be of value for considering in future similar studies. |
| Sectors | Healthcare |
| URL | https://medicinehealth.leeds.ac.uk/directories0/dir-record/research-projects/962/revamp |
| Description | Findings from this study are informing on-going engagements with State and Federal health policymakers with regards to the prioritisation of maternal and child health and design of health systems programmes to improve maternal and child health outcomes in Nigeria. |
| First Year Of Impact | 2021 |
| Sector | Healthcare |
| Impact Types | Policy & public services |
| Description | Influenced evaluation practice with article on logic models |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | Lecture on Using Logic Models in Realist Evaluation (for Postgraduate researchers, University of Leeds, UK) |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | In April 2016, a member of the REVAMP project consortium (Dr. Bassey Ebenso) delivered a lecture on using Logic models for evaluating complex healthcare programmes such as mother and child health programmes in Nigeria. As part of the lecture, Bassey: i) Defined logic models (LMs) and their usefulness to programme stakeholders; ii) Described components of LMs and processes involved in creating LMs; iii) Highlighted some of the practicalities of creating LMs and the limitations of LMs; iv) Discussed contextual factors that can influence programme evaluation and they can be addressed (using an example from Nigeria). Twenty (20) postgraduate research students from different countries in the world attended the lecture. The lecture sparked questions and discussions afterwards, and the students asked for clarification on how to use logic models for programme evaluation in their various organisations. The students later used insight and skills from the lecture to develop a logic model as part of the module assignment in Realist Evaluation. |
| URL | https://twitter.com/ana__manzano/status/725756387087757312 |
| Description | Community-led Responsive and Effective Urban Health Systems (CHORUS) |
| Amount | £7,900,000 (GBP) |
| Organisation | UK Department for International Development |
| Sector | Public |
| Country | United Kingdom |
| Start | 05/2020 |
| End | 04/2026 |
| Title | Methodology handbook for realist evaluation of community health workers (CHWs) programme in Nigeria |
| Description | We have developed a methodology handbook outlining the mixed-methods and multi-disciplinary approach that adopted realist evaluation as an overall methodological framework. This handbook is currently guiding investigation of how the deployment of trained community health workers interacts with other health systems interventions (i.e. infrastructure, equipment and supplies) and the wider context to improve access to maternity services and health outcomes in Nigeria. The approach combines: i) sociological analysis of the views of key actors, ii) statistical analysis of quantitative data of utilization of maternal health services; and iii) economic evaluation of benefits and cost of interventions. The handbook is publicly available on the project website: http://medhealth.leeds.ac.uk/info/691/research/1882/revamp |
| Type Of Material | Improvements to research infrastructure |
| Provided To Others? | No |
| Impact | The developed methodology will be used for evaluating the impact of a novel community health workers programme in improving equitable access to quality maternal health services and health outcomes in Nigeria. This will be responding to the research interests, and demand, from the Federal Ministry of Health in Nigeria and the Anambra State government (Eastern Nigeria). We anticipate that in the longer-term the handbook will inform designs of similar studies adopting theory-driven evaluation approaches and utilising mixed-methods study designs in evaluating interventions within health systems of low and middle income countries. |
| URL | http://medhealth.leeds.ac.uk/info/691/research/1882/revamp |
| Title | Pre-implementation logic model of a national programme in Nigeria |
| Description | We developed a logic model for mother and child health (MCH) care component of the Subsidy Reinvestment and Empowerment Programme in Nigeria. The logic model graphically de-constructed our (i.e. researchers, policy makers and implementers) current understanding of how the programme should work in the context of Nigeria by illustrating complex relations between key actors, context, implementation process, outputs and outcomes of programme interventions. This logic model is used as tool for informing the initial programme theories. The logic model also served as a focal point for discussions and decisions about data collection and analysis by displaying when, where, and how to obtain information most needed to assess the programme and its context. |
| Type Of Material | Data analysis technique |
| Year Produced | 2015 |
| Provided To Others? | Yes |
| Impact | In November 2015, we presented a poster outlining the process of developing the logic model at a State of the Art Realist Methodologies Conference in Leeds (UK), to a group of over 50 realist evaluation researchers from across multiple continents. The poster is now publicly available to download on Researchgate and has led to 54 downloads from researchers representing multiple continents. Members of the author team also received a number of requests for copies of the poster, illustrating the academic interest in this output. |
| URL | http://dx.doi.org/10.13140/RG.2.1.1302.5042 |
| Description | Follow-on research projects with the same collaborators |
| Organisation | University of Nigeria |
| Country | Nigeria |
| Sector | Academic/University |
| PI Contribution | The long-standing collaborative links between the Universities of Leeds and Nigeria have been extended into the areas of research on social inclusion and urban sustainability with further partners added from Hanoi University of Public Health, University of York, the ARK Foundation Bangladesh and others. The partners have secured grants from the QR GCRF and GCRF Clusters calls for joint work on social inclusion. The Projects are led by the University of Leeds team (Prof Tolib Mirzoev and Dr Ghazala Mir, respectively) |
| Collaborator Contribution | The Nigerian partners have contributed to conceptualising the ideas and writing up the project proposals. The projects involve Prof Benjamin Uzochukwu and Prof Obinna Onwujekwe. |
| Impact | Protocol for the systematic review: Tolib Mirzoev, Neil Winn, Yun Yun Gong, Ghazala Mir, Kerina Tull, Judy Wright, Natalie King. Systematic review of theoretical underpinnings of, and consideration of social inclusion within, urban sustainability. PROSPERO 2020 CRD42020165008 |
| Start Year | 2019 |
| Description | African Health Economics and Policy Association (AfHEA) conference in Ghana |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 500 researchers from across the world attended the tenth African Health Economics and Policy Association (AfHEA) conference in Ghana in March 2019 and about 70 participated in the REVAMP project World café where findings from five thematic areas of the REVAMP project (Security, Costing, Workforce Motivation, Health Management Information System and Advocacy) were shared and extensively discussed. The discussions led to the identification of ways for improving community health worker practices and programmes in low- and middle-income countries. As such we anticipate the the longer-term effects wil include improved effectiveness of the community health workers in enhancing access to healthcare, contributing to improved health outcomes and ultimately informing improvements to the socio-economic development and welfare in low- and middle income country contexts. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://twitter.com/nighealthwatch/status/1105179077881876481?s=20 |
| Description | Annual conference of the West African College of Physicians in Dakar, Senegal |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In October 2017, two members of the REVAMP project attended the annual conference of the West African College of Physicians in Dakar, Senegal, to introduce the REVAMP project to, and raise awareness of stakeholders about preliminary findings of the project. There were over 500 participants from over 12 West African countries and some representatives from Europe (Royal College of General Practitioners UK) in attendance. Groups represented included physicians (public health, paediatricians); researchers/academics and policymakers. Professor Uzochukwu addressed the audience on one of the days of the conference. In response to requests for further information, hard copies of the HMIS policy brief produced by the project were handed out to select participants and were invited to further discussions if they so required. |
| Year(s) Of Engagement Activity | 2017 |
| URL | http://www.wacpsenegal.org/# |
| Description | Contribution to a panel at 12th biennual conference of European Evaluation Society |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | in September 2016 Dr Ana Manzano shared a case study of design of Realist Evaluation from the REVAMP project at an organised panel at biennual conference of European Evaluation Society (EES). The panel, which consisted of five presentations of which REVAMP was one, shared examples of realist evaluations that have focused on program and policy impacts for discussion. The presentation from REVAMP focused on identifying the connection between the ideas about context-mechanism-outcome configurations with ideas of evaluation design. The presentation sparked interest and subsequent engagement from the audience in a form of requests for further information about the project and its evaluation approach. |
| Year(s) Of Engagement Activity | 2016 |
| URL | http://ees2016.eu/online-programme.htm |
| Description | Lecture on using logic models in realist evaluation delivered to postgraduate students (University of Leeds, UK) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | In April 2016, a member of the REVAMP project team, Dr. Bassey Ebenso delivered a lecture on using Logic models for evaluating complex healthcare programmes such as mother and child health programmes in Nigeria. As part of the lecture, Bassey: i) Defined logic models (LMs) and their usefulness to programme stakeholders; ii) Described components of LMs and processes involved in creating LMs; iii) Highlighted some of the practicalities of creating LMs and the limitations of LMs; iv) Discussed contextual factors that can influence programme evaluation and they can be addressed (using an example from Nigeria). The lecture sparked questions and discussions afterwards, and the postgraduate students subsequently asked for clarification and guidance on how to develop logic models for programme evaluation. The students later used insights from the lecture to develop a logic model as part of the module assignment in Realist Evaluation. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/ana__manzano/status/725756387087757312 |
| Description | Mechanisms of motivation for primary health workers. Insights from a realist evaluation of a maternal and child programme in Nigeria (by Dr. Bassey Ebenso). |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 80 researchers, postgraduate students and policymakers from across the globe attended a RealismLeeds webinar series on 5th February 2021, at which Dr Ebenso presented the paper he led on the same topic in BJ Global Health (https://gh.bmj.com/content/5/8/e002408.info). The webinar sparked questions and discussions among researchers concerning theoretical underpinnings of health workforce motivation in resource-constrained settings. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://realism.leeds.ac.uk/realismleeds-webinar-series/ |
| Description | National Research Dissemination Workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | In January 2020, the REVAMP project organized a dissemination workshop to feedback findings from the 5-year study to national-level stakeholders in Abuja Nigeria. The findings of the research were presented in the form of seven (7) Thematic Policy Briefs. A total of 58 stakeholders from a range of organizations attended the workshop including Federal Ministry of Health, National Primary Health Care Development Agency, Federal Governor's Forum; and Non-Governmental Organisations such as the UNFPA and UNICEF. The methodology for the workshop included brainstorming sessions, interactive discussions, presentations, and a world café. Findings from the seven thematic areas of the project (Security, Costing, Trust, Motivation, Health Management Information System (HMIS), Advocacy, and Advocacy Coalition) were discussed. Outputs of the event included: i) Identification of gaps in policy and how to address such gaps to accelerate the achievement of SGD 3 i.e. the health of people of all ages; and ii) Recommendation of key areas for future research. By accelerating the attainment of SDG 3, the REVAMP project contributes to the economic and societal development and welfare in Nigeria. |
| Year(s) Of Engagement Activity | 2019,2020 |
| URL | https://twitter.com/TMirzoev/status/1222213370419376128?s=20 |
| Description | Oral Presentation at the 5th Global Symposium on Health Systems Research by Dr Enyi Etyaba |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Up to 50 researchers from across the world attended who attended the 5th Global HSR symposium in Liverpool, listened to our oral presentation titled: "If this place is secure, I will give them what they want" - Experiences of Providers and Users of maternal and child health services in Nigeria. The talk, delivered by a member of the REVAMP team Dr. Enyi Etiaba, sparked questions and discussions afterwards, and different participants asked for additional information about how physical security can be improved in health facilities in similar contexts. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Oral presentation at the 2nd International Conference on Realist Evaluation and Synthesis (London UK). |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In October 2016, a member of the REVAMP project team, Dr. Ana Manzano, gave an oral presentation on "Capacity Building Models in Realist Evaluation", at the CARES conference in London. The round-table discussion which provided a platform to share REVAMP project RE capacity building activities in Nigeria (e.g. webinars) and the impact of these. The round-table discussion sparked questions and debate afterwards, and the researchers asked for additional information on using different models of capacity building in low- and middle-income countries. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://www.twitter.com/ana__manzano/status/783585940002443264 |
| Description | Oral presentation at the Fourth Global Symposium on Health Systems Research (Vancouver, Canada) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | At the 4th Global Symposium on health systems research held in Vancouver, Canada in 2016, Dr. Tolib Mirzoev gave an oral presentation sharing "Key lessons from using mixed-methods realist evaluation for evaluating complex interventions in Nigeria". About 60-70 symposium delegates attended the session at which the presentation was made. The talk sparked questions and discussions afterwards, and the researchers were asked for additional information on using Realist Evaluation approach for evaluating complex interventions in both high- and low-income countries. |
| Year(s) Of Engagement Activity | 2016 |
| URL | http://healthsystemsresearch.org/hsr2016/programme/symposium-programme/ |
| Description | Organised session on innovative approaches for enhancing the role of communities in health systems at HSR2018 chaired by Dr Tolib Mirzoev |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In October 2018 the members of the REVAMP and RESPOND teams led an organised session at the 5th Global Symposium for Health Systems Research, to discuss innovative approaches to enhancing the role of communities in health systems: experiences from four different countries. The session provided a platform for participants to reflect and debate issues related to enhancing community engagement in promoting appropriate treatment-seeking practices at the grassroots levels in low- and middle-income countries. The session, which was organised across the different projects including the REVAMP and RESPOND, was chaired by the REVAMP and RESPOND PI Dr Tolib Mirzoev and included members of the REVAMP (Dr Bassey Ebenso, Dr Enyi Etiaba) and RESPOND (Dr Rumana Huque). It consolidated case studies from four (4) countries namely Bangladesh, Nepal, Nigeria and Vietnam, to enable participants to share their own experiences of community health systems. The workshop led to the identification of effective approaches used to improve community health systems across the four countries |
| Year(s) Of Engagement Activity | 2018 |
| Description | Poster display at at the 5th Global Symposium for Health Systems Research |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 500 researchers from across the world attended who attended the 5th Global HSR symposium in Liverpool, viewed our poster titled: Improving prioritisation and effectiveness of maternal and child healthcare in Nigeria. The poster, displayed at a University of Leeds kiosk at the Symposium's marketplace, sparked questions and discussions afterwards, with many researchers asking for additional information on how stakeholders can advocate for/influence governments to prioritise health services for vulnerable mothers and infants. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Poster presentation at the 5th Global Symposium of Health Systems Research by Dr Bassey Ebenso |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 2,000 researchers from across the world attended the 5th Global HSR symposium in Liverpool in October 2018, and many viewed our poster entitled: What motivates primary healthcare workers to perform well in resource-limited settings: Insight from realist evaluation of health systems strengthening in Nigeria? The poster, presented by a member of the REVAMP team, Dr Bassey Ebenso, sparked questions and discussions afterwards, with one researcher commenting that our poster was the only one of >400 posters to use realist evaluation framework to assess health workforce motivation. Many researchers asked for additional information about the drivers of motivation in different cares of health workers in Nigeria. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.researchgate.net/publication/328172884_What_motivates_primary_healthcare_workers_to_perf... |
| Description | Poster presentation at the Fourth Global Symposium on Health Systems Research (Vancouver, Canada). |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 500 researchers from across the world attended who attended the 4th Global HSR symposium, viewed our poster titled: Sustainability of learning for health systems development in contexts of changing government political priorities: REVAMP experience from Nigeria. The poster, presented by Dr Tolib Mirzoev, sparked questions and discussions afterwards, and the researchers were asked for additional information on how sustainability of learning for health systems development can be achieved in similar contexts. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/NCIHD_Leeds/status/801806284005765122 |
| Description | Poster presentation at the Fourth Global Symposium on Health Systems Research (Vancouver, Canada). |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 500 researchers from across the world who attended the Fourth Global Symposium on Health Systems Research in Vancouver, viewed our poster entitled: Reflections from using logic modelling as part of realist evaluation of a community health worker programme in Nigeria. The poster, presented by Dr Bassey Ebenso, sparked questions and discussions afterwards, and the researchers were asked for additional information on how to use logic models for programme evaluation. Following their interest in the subject area, we have subsequently uploaded the poster onto the Researchgate website (https://www.researchgate.net/publication/313316367_Reflections_from_using_logic_modelling_as_part_of_realist_evaluation_of_a_community_health_worker_programme_in_Nigeria). This, in turn has led to further engagements with the poster by additional 62 researchers from different countries. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Poster presentation at the State Of The Art of Realist Methodologies Conference, Leeds UK. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | About 50 researchers from across the world attended our poster presentation "De-constructing a complex programme using a logic map: Realist Evaluation of Maternal and Child Health in Nigeria". The poster sparked questions and discussions afterwards, and the researchers asked for additional information on how to use logic maps for programme evaluation. Following their interest in the subject area, we have subsequently uploaded the poster onto the project website (http://medhealth.leeds.ac.uk/info/691/research/1882/revamp) and Researchgate website (https://www.researchgate.net/publication/283667237_De-constructing_a_complex_programme_using_a_logic_map_Realist_Evaluation_of_Maternal_and_Child_Health_in_Nigeria). This, in turn has led to further engagements with the poster by additional 116 researchers from different countries have viewed the poster to date. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://realism.leeds.ac.uk/conference2015/ |
| Description | Poster presentations at 35th Annual conference of the Association of Public Health Practitioners of Nigeria by Dr. Enyi Etiaba and Dr. Chinyere Okeke |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | In January 2019, four members of the REVAMP project attended the 35th annual conference of the Association of Public Health Practitioners of Nigeria (APHPN) held in Enugu city, Nigeria during 28 January- 01 February 2019. The objective was to introduce the REVAMP project to, and raise awareness of stakeholders about, key emerging findings from the project. There were up to 500 participants from Nigeria at the conference, representing: i) physicians (public health, paediatricians); ii) researchers/academics, iii) policymakers from federal and state ministries of health, and iv) policy implementers from various health parastatals in the country. Two posters disseminating findings of REVAMP project (Security and Advocacy) were presented by Dr. Enyi Etiaba and Dr. Chinyere Okeke respectively. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://twitter.com/SouthEastGist/status/1091304135994023936 |
| Description | Role of trust in sustaining provision and uptake of Maternal and Child Healthcare in Nigeria given at the International Realist Conference in Dublin (By Prof. Nkoli Ezumah) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 100 researchers attended the talk, which sparked questions and discussions afterward |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://realist2020.org/ |
| Description | Sensitisation of key stakeholders at a national-level workshop in Abuja, Nigeria by Prof Benjamin Uzochukwu |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In April 2018, 8 members of the REVAMP team attended the 3-day Knowledge synthesis workshop in Abuja, Nigeria. The workshop was organised by the DFID-funded RESYST (Resilient and Responsive Health Systems) Research Programme Consortium. There were over 70 participants comprising Federal and State level Policymakers, Donor organisations, Civil Society Organisations and Academicians/Researchers. Professor BSC Uzochukwu created further awareness of the on-going REVAMP project and presented the emerging findings from the on-going assessment of advocacy activities to prioritize MNCH in Nigeria's health agenda. The HMIS policy brief, produced earlier in the project, was also disseminated. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Sensitization Stakeholder Workshop for REVAMP project in Anambra State of Nigeria |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Early in 2015, the Team Leader of the REVAMP project partner in Nigeria, Professor Benjamin Uzochukwu, led a sensitization workshop for key stakeholders of REVAMP project in Anambra State (south-east, Nigeria) to introduce the research project to, and raise awareness of stakeholders about the project. Twelve (12) representatives of stakeholder groups attended the workshop which sparked questions and discussions afterwards; and led to requests for additional information about the research project from stakeholder groups. Groups represented at the workshop were: i) policy makers, ii) health professionals, iii) associations of doctors and midwives and iv) third sector organizations. In response to requests for further information, we handed out the project awareness leaflet to those present at the workshop, for distribution among their networks. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Sensitization workshop for stakeholders of REVAMP project in Enugu State of Nigeria |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | In February 2017, REVAMP project team from the University of Nigeria Enugu Campus organised information sharing workshops in Enugu state (south-east, Nigeria), to sensitise participants about the current activities of the REVAMP project. Forty-three (33) participants attended the workshop, which sparked questions and discussions afterwards; and led to requests for additional information about the research project from stakeholder groups. Stakeholders represented at the workshop were policymakers, sociologists, health planners and programme implementers. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Step-down workshop on conducting and analysing different types of realist evaluation interviews (University of Nigeria Enugu Campus, Nigeria) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | In mid-January 2018, the University of Nigeria's REVAMP Team organised 4-hour step-down workshop for fieldworkers on conducting and analysing different types of realist evaluation (RE) interviews for evaluating health systems interventions in low- and middle-income countries. The workshop aimed to prepare fieldworkers for the 2nd phase of data collection in Nigeria and used a combination of presentation, discussion and practice exercise to build the capacity/skills of participants regarding realist interviewing and analysis. A total of 12 fieldworkers from Nigeria participated in the workshop, which enhanced their capacity (knowledge and skills) in this topic. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Sub-national Research Dissemination Workshop in Anambra State of Nigeria |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | In July 2019, the REVAMP project organized a one-day feedback workshop for state-level (sub-national) stakeholders. Findings from the thematic areas of the research (Advocacy/Advocacy Coalition, Costing, HMIS, workforce Motivation, Security and Trust) were fed back to the stakeholders, who were then engaged in a World Café-style discussion where stakeholders critiqued the findings and subsequently recommended areas for further research. The discussions led to: i) Identification of how evidence in the policy briefs can contribute to the attainment of SGD 3 i.e. good health and wellbeing of people of all ages; and ii) Recommendation of key areas for future research. We anticipate that findings will inform future design of similar programmes and contribute to the attainment of SDG 3, ultimately informing economic and societal development in Nigeria. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://twitter.com/eetiaba/status/1148620764544937984?s=20 |
| Description | Tracing theories in realist evaluations of large-scale health programmes in LMICs given at the International Realist Conference in Dublin (by Prof. Tolib Mirzoev) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Over 200 participants from across the globe attended the oral presentation (at the INTERNATIONAL REALIST CONFERENCE 2021), which sparked questions and discussions afterwards. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://www.youtube.com/watch?app=desktop&v=T6dr0R6W6ec |
| Description | Tracing theories in realist evaluations of large-scale health programmes in low- and middle-income countries (By Prof. Tolib Mirzoev). |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Over 100 persons across the globe attended a Realism Leeds webinar (on 2nd October 2020) in which Prof Tolib Mirzoev presented the processes of gleaning, developing, testing, consolidating and refining programme theories (PTs) from a longitudinal mixed-methods evaluation of a national maternal and child health programme in Nigeria, drawing on a paper he led which has been published in Health Policy and Planning (https://academic.oup.com/heapol/article/35/9/1244/5900843). The presentation sparked questions and discussions afterwards. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.youtube.com/watch?v=uZOcVwqcWFQ |
| Description | Visit to the Office of the Commissioner for Health in Anambra State , Nigeria |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | In August 2015, the Team Leader of the REVAMP project partner in Nigeria, Professor Benjamin Uzochukwu, organized a high-level meeting with the Health Commissioner of the Ministry of Health in Anambra State in Nigeria. The objectives of the meeting were to introduce the project to state-level policymakers and politicians to raise their awareness about the study, and to seek their endorsement and further support for the project. Six politicians and policy makers attended the meeting, which sparked questions and discussions on the project contents and approach, and led to expression of high interest among politicians and policy-makers in assessing the performance of the SURE-P programme and the key contextual factors that influence achievement of programme objectives. During the meeting, we also handed out the project awareness leaflet to these key stakeholders who agreed to further distribute the leaflet within their organisations and networks. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Webinar on data analysis in realist evaluation organised for REVAMP members |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In early December, 2016, the Leeds REVAMP Team organised a 3-hour webinar on analysing qualitative data in Realist Evaluation and the application of Realist Methodology for evaluating health systems interventions in low and middle income countries. A total of 10 researchers from Nigeria and the the UK participated in the webinar, which enhanced their capacity (knowledge and skills) in this topic. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://twitter.com/ana__manzano/status/809316796025147392 |
| Description | Workshops on conducting and analysing different realist evolution interviews (University of Leeds, UK) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | In mid-September 2017, the University of Leeds REVAMP Team organised two, 2-hour workshops on conducting and analysing different types of realist evaluation (RE) interviews for evaluating health systems interventions in low- and middle-income countries. The workshops, which aimed to prepare REVAMP project members for the 2nd phase of data collection, used a combination of presentation, discussion and practice exercise. A total of 10 researchers from Nigeria and the UK participated in the two workshops, which enhanced their capacity (knowledge and skills) regarding realist interviewing and analysis. |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://twitter.com/B_Ebenso/status/907659586626351106 |