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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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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 Programme

No. of women1

Antenatal visit 1

Antenatal visit 4

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

64%

70%

62%

Skilled attendant at birth

Postnatal care

Family Planning

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

Continuum of care

480,000

186,000

56,000

n/a

20,000

1 2009 figures

SOURCE: MSS baseline report


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

Recruitment

Deploy-ment

Training

Payment

Conditions

Ident-ification

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

SOURCE: PIU team


Hospital through supply and demand-side interventions along the continuum of care

CHEWs

CHEWs

CHEWs

VHWs

VHWs

CHEWs

VHWs

VHWs

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

WDC

Client

Client

Midwives

Midwives

PHC

PHC

referral

PHC

PHC

referral

Client

Client

Midwives

Midwives

WDC

SOURCE: MCH PIU


Sure p mch demand interventions cct
SURE-P MCH through supply and demand-side interventions along the continuum of careDemand 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).

SOURCE: MCH PIU


1) through supply and demand-side interventions along the continuum of careN 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

1000

  • 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.

1000

2000

1000

  • 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 through supply and demand-side interventions along the continuum of care 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 through supply and demand-side interventions along the continuum of care

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.

SOURCE: MCH PIU


Mcct mhealth collaboration with pathfinder international nigeria
mCCT through supply and demand-side interventions along the continuum of care: 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 through supply and demand-side interventions along the continuum of carewith 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


Thank You For Listening! through supply and demand-side interventions along the continuum of care


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