Abstract

Background
Due to insufficient progress in reaching Millennium Development Goals 4 and 5, the Nigeria Federal Ministry of Health approved and prioritized the implementation of the Maternal Newborn and Child Health week (MNCHW) to accelerate progress. The MNCHW is a week-long, bi-annual one-time delivery mechanism aimed at strengthening and consolidating routine Primary Health Care (PHC) services and significantly increasing coverage of core preventive and curative interventions that can improve health of mothers and children.
After 5-years of MNCHWs implementation, an impact evaluation (IE) was commissioned to 1)-Assess the extent to which the MNCHWs have been implemented as intended, 2)-Evaluate the extent to which the MNCHW has been adapted to the needs of intended target groups, 3)-Assess whether the intended outcomes of the MNCHW were achieved, and whether there were unintended outcomes, 4)-Identify lessons learned, and 5)-Make recommendations to strengthen the MNCHWs.
Method
An evaluability assessment concluded that, a credible, reliable and useful IE could be conducted. The IE was conducted using Theory based approach, specifically contribution analysis. The MNCHW Theory of Change (ToC) was refined and validated by stakeholders.
Twelve states and the FCT were systematically but purposefully selected for data collection.
Primary data was collected from a household survey-(n=5, 389), key informant interviews-(46) and focus group discussions-(28) were carried out. Secondary data was extracted from relevant reports, data sets and publications.
Results
Since inception the MNCHWs has not been implemented according to the MNCHWs implementation guidelines. Only 27.8% of women and children under 5-years in the HHS participated in the MNCHWs preceding the survey. The odds of attending the MNCHWs was 50 times more in women who were aware than those who were unaware of the MNCHWs (OR 47.3, 95% CI 34.6, 64.4). There was no evidence that the MNCHW has significantly contributed to coverage of essential MNCHW interventions or improved MNCH outcomes. Other key findings were poor political commitment to funding, inconsistent implementation approach, dependency of PHC functioning on MNCHWs, weak MNCHW implementation monitoring system, ineffective social mobilization strategy, negative effect of immunization-plus-days on MNCHWs planning and implementation, and poor training of health care workers.
Conclusion
The intended outcomes of the MNHWs have not been achieved and the PHC system has not been strengthened.
Thirteen policy and operational levels recommendations were made to improve its implementation and phase-out to allow for full implementation of a new national PHC policy in the SDG era.