USAID/Nigeria integrated health program : mid-term evaluation final report

The goal of the Activity was to contribute to state-level reductions in child and maternal morbidity and mortality, and to increase the capacity of public and private health systems to sustainably support quality primary health care (PHC). Between 2018 and 2019, Task Orders (TOs) 2–5 were awarded, covering federal support and Bauchi, Kebbi, and Sokoto states, respectively. USAID/Nigeria contracted the Nigeria Monitoring, Evaluation and Learning Support Activity (MELSA) to conduct a mid-term performance evaluation of IHP focusing on TOs 2–5, to assess performance, identify constraints, and recommend actions for improvement. The evaluation team (ET) used mixed methods, including a document review, key informant interviews (KIIs), and focus group discussions (FGDs), to identify findings that addressed USAID’s evaluation questions. The evaluation found that the scope of IHP’s integrated approach was relevant to national and state priorities. However, the integration of health financing and governance was too broad and was not delivering results. There have been improvements in immunization and postnatal care (PNC). Nonetheless, antenatal (ANC) visits, early initiation of breastfeeding, and children consuming a minimum diet have declined. Neonatal and under-five mortality rates (UFMR) worsened in two out of three states. Sustainability measures instituted in the IHP states have shown improvements from baseline levels in 2019 to 2021, but these improvements have not been across all the strategic sustainability pillars (SPs). Relationships built and leveraged at the federal level by IHP were much weaker than at the state level. While the federal level counterparts appreciated the limited technical assistance provided by IHP under TO 2, they also indicated that IHP could do more to further strengthen that relationship at the federal level with stakeholders working on key areas, such as PHC and family health. Moreover, IHP has struggled with communication and collaboration with other USAID Health, Population, and Nutrition (HPN)-funded activities. COVID-19 impacted IHP by slowing down some of the IHP intervention activities and switching training and meetings to a virtual mode. The report makes five recommendations directed to IHP stakeholders and USAID/Nigeria for improvements and for future design.