Improving Health Outcomes for Children Under Five in Nigeria

The program's child health goal was to reduce deaths in children under five years of age from pneumonia, diarrhea, malaria, malnutrition, and other treatable causes by increasing the coverage and quality of public and private sector child health services. Nigeria is the most populous country in Africa, with an under-five mortality rate of 128 per 1,000 live births, making it the largest contributor in Africa and the second largest contributor in the world to under-five deaths, according to UNICEF. MCSP's child health assistance began in 2015 at the national level and expanded to Ebonyi and Kogi states in late 2016. The program worked at national and state levels with public and private sector stakeholders, including the Federal and State Ministries of Health, the National and State Primary Health Care Development Agencies, the Pharmaceutical Council of Nigeria, and others. MCSP successfully advocated for policy changes that increased equitable access and improved the quality of care for malaria, pneumonia, diarrhea, and other childhood conditions. The program reviewed and contributed to new and updated national child health policies, guidelines, and plans through existing child health coordination mechanisms, including the Core Technical Committee for maternal, newborn, and child health, the iCCM Task Force, the Child Health Technical Working Group, and their sub-committees. Key results of the program include the deregulation of Amoxicillin Dispersible Tablets (Amox-DT), which are now available over the counter and included on the PPMV Essential Medicines List. The National Child Health Policy was updated, and new National Child Health Advocacy and Strategic Plan was finalized. Pre- and in-service IMCI training modules were reviewed and updated, and modules on community health management information systems (CHMIS) and logistics management information systems (LMIS) were added to iCCM modules. In Kogi and Ebonyi states, MCSP worked with the State Ministries of Health and Primary Health Care Development Agencies to reintroduce Integrated Management of Childhood Illness (IMCI), strengthen supervision and mentoring of health workers, and take other actions to improve the quality of care provided for sick children in government-owned primary health care facilities. The program rolled out integrated Community Case Management of Childhood Illness (iCCM) through PPMVs and tested this approach through the "Enhancing Quality iCCM through PPMVs and Partnerships" (EQuiPP) learning activity. The program took a systems approach, working with states to influence their policies and plans, strengthen coordination platforms, strengthen MNCH supply chains, promote appropriate care-seeking practices, refine and use the community modules from Nigeria's health management information system (HMIS) with PPMVs, and demonstrate the power of public-private partnership in service delivery, commodity availability, and human resource management. Key results of the program include the training of 246 frontline workers in IMCI, with 119 government PHC facilities in Ebonyi and Kogi with improved capacity to provide quality IMCI services. The program treated 8,452 cases of childhood pneumonia, 6,434 cases of childhood diarrhea, and 44,870 children with ACTs for malaria from October 2016 to September 2018. IMCI pre-service education was reactivated and institutionalized in seven tertiary Basic Health Institutions. The program also supported the development of a sustainable drug financing strategy for essential childhood medicines in Ebonyi state. MCSP's approach to child health policies, planning, and coordination mechanisms included advocating for the deregulation of Amox-DT, strengthening national coordination mechanisms, and updating child health policies and plans. The program worked with the Federal Ministry of Health to strengthen the coordination and planning mechanisms that shape Nigeria's child health policies and programs. MCSP also participated in the national iCCM Task Force and its sub-committees on advocacy, communication, and resource mobilization; monitoring and evaluation; and essential childhood medicines.