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Where We Work : Nigeria
Nigeria
Increasing Use of High-Quality Services
A focus group discussion session with older women
With funding from USAID/Nigeria, ACCESS has designed and is
implementing a three and half-year program focused on increasing the use of
high-quality emergency obstetric, newborn and family planning services in two
northern Nigerian states—Zamfara and Kano. Beginning with two local government
authorities (LGAs) in each state the first year and expanding to additional LGAs
and states over time, ACCESS is contributing to the reduction of maternal and
neonatal mortality, as well as USAID’s strategic objective 13: Increased Use of
Child Survival and Reproductive Health Services.
The key program approach to achieving these objectives is the implementation of integrated community and facility-based care using the
Household-to-Hospital Continuum of Care (HHCC) approach. This approach recognizes the importance of a successful emergency obstetric and newborn care program to systematically address issues at both the community- and facility-levels together using evidence-based interventions and best practices. The HHCC addresses all three delays associated with maternal and newborn deaths by improving household and care-seeking practices, empowering the community to create and maintain an enabling environment for increased utilization of EMNC services—whether public or private—and improving the quality of care provided at the peripheral and district levels.
Kano and Zamfara states, which have particularly high maternal and newborn mortality rates, are predominantly rural and poor. Skilled attendance at delivery in the North West is the lowest of all 6 zones, and less than 1 percent of births are attended by a doctor. The total fertility rate in the area is 6.7, with only 3 percent of women using modern contraception. Within selected LGAs ACCESS is covering a critical mass of wards and villages with behavior change communication and community mobilization interventions to gain LGA-wide impact. For facilities, ACCESS has followed United Nations standards for a population of 500,000 inhabitants which requires at least four facilities to provide 24 hours/7days coverage of EmONC services as well as one facility for comprehensive EmONC.
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