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Subsidy Re-investment and Empowerment Programme (SURE-P) Maternal and Child Health (MCH) Programme Overview of Conditional Cash Transfer Pilot Programme. January 2014. Overview of the SURE-P Maternal and Child Health (MCH) Programme.

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January 2014

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January 2014

Subsidy Re-investment and Empowerment Programme (SURE-P) Maternal and Child Health (MCH) ProgrammeOverview of Conditional Cash Transfer Pilot Programme

January 2014

Overview of the sure p maternal and child health mch programme

Overview of the SURE-P Maternal and Child Health (MCH) Programme

  • The SURE-P objective is to mitigate the impact of the fuel subsidy reduction on vulnerable populations in Nigeria by initiating a robust social safety net programme to improve their lives

  • The MCH component aspires to contribute to the reduction of maternal, and newborn morbidity and mortality and increase maternal access to health services through two forms of intervention:

    • Supply side: providing primary health care (PHC) facilities with health workers, infrastructure upgrades, and commodities to enable sufficient and quality service delivery.

    • Demand side: providing conditional cash transfers (CCTs) to pregnant women in communities across the nation to encourage them to go through the full continuum of maternal, neonatal, and child health (MNCH) services.

  • The programme builds off the Midwives Service Scheme (MSS) of the National Primary Health Care Development Agency (NPHCDA), a parastatal of the Federal Ministry of Health.

In nigeria very few pregnant women go through the full continuum of care

% lost per step

No. of women1

Antenatal visit 1

Antenatal visit 4

~4% of women who attend one ANC visit go through the full continuum of care




Skilled attendant at birth

Postnatal care

Family Planning

In Nigeria, very few pregnant women go through the full continuum of care

Continuum of care






1 2009 figures

SOURCE: MSS baseline report

January 2014

The SURE-P MCH programme will build on the impact of MSS through supply and demand-side interventions along the continuum of care







Antenatal visit 1

Antenatal visit 4

Skilled attendant at birth

Postnatal care

Family Planning

Supply Inputs

Demand Inputs

Continuum of care

Human Resources for Health

Conditional Cash Transfer

  • Midwives and CHWs recruited from school or unemploy-ment database, VHWs from commu-nities

  • Midwives and CHWs deployed after enrolment, VHWs deployed after training

  • All cadres receive a one-week training

  • Women who meet conditions are paid a set incentive value

  • Women are encour-aged to meet programme conditions (i.e. to access MCH services at PHCs)

  • Pregnant women in the community identified by VHW, CHW, or midwife


January 2014










In the SURE-P cluster system, health workers are deployed to reach deeper into target communities with the help of ward development committees

  • WDCs play important roles in this system:

    • Ensure women are aware of the programme and receive its benefits

    • Monitor implementation within community

  • WDCs and health workers active in communities to refer women to PHCs

  • Hospitals key for providing services for complicated pregnancies and births


















Sure p mch demand interventions cct

SURE-P MCH Demand Interventions (CCT)

The overall goal of the CCT component of the SURE-P MCH Programme is to increase demand for basic MNCH services among pregnant women in the communities supported by this programme.

Specifically, the programme objectives are to:

  • Reduce maternal and infant mortality by encouraging pregnant women to go through the full continuum of MNCH services, from their first ANC visit through to postnatal care for the newborn

    • Increase pregnant women’s welfare by providing them with cash support to reduce the impact of economic barriers to access to health services (e.g. transport to the PHC).


January 2014

1) N 1000

Amount (NGN)

Registration + 1st ANC

Disbursement Tranches

ANC 2, 3 and 4

2) N 4000

Skilled attendant at birth

Postnatal care + Immunization

Family Planning Advice

The SURE-P MCH Conditional Cash Transfer Programme is designed to encourage women to complete the continuum of care for MNCH services

Continuum of care

CCT Co-Responsibilities


  • There are four co-responsibilities in the CCT programme, spread sequentially over the continuum of care.

  • Beneficiaries are entitled up to N5000 cash support if they meet all 4 co-responsibilities, received in 2 disbursements.

  • Cash support to beneficiaries is pro-rated based on verification of co-responsibilities met.

  • Any CCT beneficiary referred to a SURE-P General Hospital at any point in the continuum of care receives free care, with all costs covered by the CCT programme.




  • As at the end of 2013, approximately 14,500 women had enrolled for the CCT Pilot Programme in 8 states and Federal Capital Territory (FCT).

Mhealth and mobile money opportunities in cct

mHealth and mobile money opportunities in CCT

Mobile technology at different levels can improve our efficiency and patient care:

SURE-P actions to expand CCT

mHealth potential

  • Health workers can register patients and enter health records on tablet devices.

In health facilities

  • Partneringwith Pathfinder International to make CommCare applications available for health workersand CHEWs.

  • Decision-making applications can tailor information to the beneficiary’s history.

  • CHEWs can use tablets to view and update beneficiary records on their visits, improving data completeness.

In the community

  • Applications recording patient contact details can be used to send women appointmentreminders (to improve service uptake and retention) and health advice

  • Currently using ANC days and cash transfer days to provide supplementary mass health advice.

  • Hoping to leverage on Pathfinder collaboration to provide individual adviceand reminders.

For beneficiaries

  • In development to be provided as part of Pathfinder collaboration.

  • Women can receive cash support by transfers to mobile wallets.

Cash transfers

Plans for cash support using mobile money

Plans for cash support using mobile money

At present, the CCT Pilot Programme is distributing physical cash to beneficiaries

  • Cashier distribution is not sustainable for the programme, though it is perceived as more transparent by beneficiaries.

  • Mobile money transfers have lower overhead costs and fewer security issues than physical distribution of cash.

  • Challenges for mobile money:

    • Low financial inclusion and mobile penetration.

    • Relative unpopularityand low trust among women (>90% women in SURE-P pre-pilot opted for cashier disbursement).

  • Any mobile cash disbursement method must take this into account:

    • Use community-level structures (e.g. mobile agents) for women to access their funds.

    • Advocacy to build trust among beneficiaries.


Mcct mhealth collaboration with pathfinder international nigeria

mCCT: mHealthcollaboration with Pathfinder International Nigeria

Pathfinder has developed CommCare applications for use in SURE-P CCT facilities

  • Pathfinder International Nigeria has been piloting a mHealth intervention, providing CHEWs with mobile phones equipped with a decision-making application.

  • SURE-P MCH is partnering with Pathfinder to make mHealth applications available in a selection of CCT facilities.

  • The decision-making application can be used in facilities and communities by health workers and CHEWs/VHWs.

  • Pathfinder are also developing a mobile payment application for use in the SURE-P CCT.

  • Linked beneficiarydatacan be drawn from HMIS records and CCT databases to create a unified CCT dashboard.

  • The collaboration is currently a pilot in Federal Capital Territory (FCT),which may be expanded to other SURE-P clusters later in 2014.

SOURCE: MCH PIU; Pathfinder International

Sure p mch collaboration with clinipak mobile health project

SURE-P MCH collaboration with CliniPAK Mobile Health Project

SURE-P is joining a pilot NPHCDA collaboration with Qualcomm funded project

  • Provides Android tablet-based application to midwives in NPHCDA clinics.

  • The application is used for assessment, management and referral of pregnant women.

  • Application generates reports automatically, including:

    • ANC & Pregnancy Outcomes

    • Mortality & Morbidity

    • Immunizations

    • Referrals

    • Monthly Records of Growth Monitoring, Family Planning, ANC and Pregnancy Outcomes in District & LGA

    • NHIS & Area Council Monthly Summary Forms

  • Other stakeholders include:

    • Vecna Cares Charitable Trust [CliniPAK software]

    • Etisalat [subsidised/free data plans]

    • Evidence For Action [program M&E and reporting]

    • InStrat Global Health Solutions [project management]

  • The collaboration at pre-pilot stagein Federal Capital Territory (FCT),with the main pilot scheduled in three states for November 2014.

SOURCE: MCH PIU; Pathfinder International

January 2014

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