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(SQUEAC) Birnin Magaji LGA's CMAM Programme Zamfara State, Northern Nigeri

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(SQUEAC) Birnin Magaji LGA's CMAM Programme Zamfara State, Northern Nigeri Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) Birnin Magaji LGA’s CMAM programme Zamfara State, Northern Nigeria June 2014 Adamu Abubakar Yerima, Ayobami Oyedeji, Salisu Sharif Jikamshi and Ode Okponya Ode Save the Children International Acknowledgement The SQUEAC assessment in Birnin Magaji LGA was accomplished through the generous support of Children Investment Fund Foundation (CIFF). Special thank goes to the Federal Ministry of Health (FMOH), Zamfara State Ministry of Health (SMOH), Birnin Magaji Local Government Area (LGA) and Birnin Magaji LGA Health Facilities’ Staff and of prominent note, the Permanent Secretary, Director Primary Health Care & State Nutrition Officer of Zamfara State (SMOH), the Chairman and Director PHC of Birnin Magaji LGA for their collaboration in the implementation of the SQUEAC1 assessment in the state. Our profound gratitude goes to the care givers and various community leaders for sparing their precious time and opening their doors to the SQUEAC team without which this investigation would not have been a reality. Finally and most importantly, we wish to appreciate the technical support of Adaeze Oramalu (Nutrition Advisor) and Lindsey Pexton (Senior Nutrition Adviser, Save the Children International), Joseph Njau of ACF International and Coverage Monitoring Network (CMN) in analyzing the data and compilation of this report. 1 Semi Quantitative Evaluation of Access and Coverage ii Table of contents Abbreviations ............................................................................................................................................................... vi Executive summary .................................................................................................................................................... vii 1. Introduction ........................................................................................................................................................ 9 2. Objectives ......................................................................................................................................................... 10 3. Methodology .................................................................................................................................................... 10 3.1. Stages of SQUEAC of Birnin Magaji LGA CMAM program ........................................................................... 11 4. Results and Findings ......................................................................................................................................... 15 4.1. Stage 1 : Identification of barriers and boosters and of potential areas of high or low coverage ............ 15 4.1.1. Routine monitoring data and individual OTP cards ................................................................................. 15 4.1.2. Qualitative data ........................................................................................................................................ 23 4.1.3. Boosters, Barriers and Questions (BBQ) .................................................................................................. 25 4.1.4. Concept Map ............................................................................................................................................. 26 4.2. Stage 2: Confirmation areas of high and low coverage ........................................................................... 26 4.2.1. Small area survey .............................................................................................................................. 26 4.2.2. Barriers of the small area survey ...................................................................................................... 27 Table 4: Barriers of the small area survey......................................................................................................... 27 4.3. Stage 3: The coverage estimate (application of Bayesian Theory) ......................................................... 28 4.3.1. Development of Prior ....................................................................................................................... 28 4.3.2. Likelihood .......................................................................................................................................... 34 4.3.3. Posterior ............................................................................................................................................ 36 5. Discussion ......................................................................................................................................................... 37 6. Conclusion ........................................................................................................................................................ 38 7. Recommendations ........................................................................................................................................... 39 Annex 1: Itinerary of the mission ............................................................................................................................. 41 Annex 2: List of participants .................................................................................................................................... 42 Annex 3: Seasonal calendar ...................................................................................................................................... 43 Annex 4: Survey Questionnaire for caregivers with cases NOT in the programme ............................................... 44 Annex 5: Pictures of Concept map carried out by the two teams .......................................................................... 55 Annex 6: Barriers to program access and uptake-small area survey. ..................................................................... 56 Annex 7: Wide are survey results ............................................................................................................................. 57 Annex 8: Summary of qualitative findings ............................................................................................................... 58 iii List of figures FIGURE 1: MAP OF BIRNIN MAGAJI LGA SHOWING LOCATION OF WARDS AND OTP SITE ................................................................................. 9 FIGURE 2: STAGES OF SQUEAC ........................................................................................................................................................... 11 FIGURE 3: PROCESS OF COLLATION ENTRY AND ANALYSIS OF THE ROUTINE AND OTHER PROGRAM DATA ............................................................. 11 FIGURE 4: NUMBER OF ADMISSIONS BY HF FROM ROUTINE DATA EXTRACTION .............................................................................................. 15 FIGURE 5: NUMBER OF ADMISSION BY HF FROM LGA DATA ...................................................................................................................... 16 FIGURE 6: PROPORTION OF ADMISSIONS BY LGA OF CASES ........................................................................................................................ 16 FIGURE 7: ADMISSION TREND OVER TIME FOR THE LGA PERFORMANCE DATA AND ROUTINE DATA EXTRACTED .................................................... 17 FIGURE 8: ADMISSION TREND AND SEASONAL CALENDAR .......................................................................................................................... 17 FIGURE 9: ADMISSION TREND BY HF ..................................................................................................................................................... 18 FIGURE 10: THE PLOT ADMISSION MUACS SHOWING THE MEDIAN ADMISSION MUAC IN BLACK ..................................................................... 18 FIGURE 11: A HISTOGRAM REPRESENTATION OF THE LOS WITH MEDIAN LOS SHOWN BY ARROW IN BLACK ........................................................ 19 FIGURE 12: A BAR CHART REPRESENTATION OF EXIT MUAC ...................................................................................................................... 19 FIGURE 13: PIE CHART REPRESENTATION OF PROGRAM INDICATORS FOR THE PERIOD JAN 2013 TO MAY 2014 (A) ROUTINE PROGRAM DATA AND (B) MONTHLY LGA PERFORMANCE DATA ........................................................................................................................................... 20 FIGURE 14: TRENDS OF PERFORMANCE INDICATOR FROM THE ROUTINE DATA ............................................................................................... 20 FIGURE 15: DISAGGREGATION OF RECOVERY RATE BY HF ......................................................................................................................... 21 FIGURE 16: DISAGGREGATION OF NON-RECOVERED RATE BY HF ................................................................................................................ 21 FIGURE 17: HISTOGRAM REPRESENTATION OF NUMBER OF VISITS AT DEFAULT .............................................................................................. 22 FIGURE 18: A BAR CHART PRESENTATION OF MUAC AT DEFAULT ............................................................................................................... 22 FIGURE 19: SHOWS DISTRIBUTION OF DEFAULTERS BY LGA ....................................................................................................................... 23
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