ACCELERATED ACTION FOR IMPACT © UNICEF/Andrew Esiebo Improving maternal, newborn and child health in Oyo State Context Oyo State has an estimated population of 8.4 million, of which approximately 1.7 million are children under 5 years of age. In terms of child health, Oyo is characterized by high neonatal mortality and low levels of immunization. Oyo State ranks third after Kano and Jigawa in terms of numbers of neonatal deaths and contributes more than a third of all babies dying in Nigeria before 1 year of age. While the state has made some progress 87% of pregnant women make at least four antenatal care visits. in child health since 2011, the data reveal that 80% of births are delivered by a skilled approximately 38 babies die each day in Oyo, attendant. primarily from sepsis and birth asphyxia, and fewer than four in 10 children are fully 37% of children aged 1 year are fully immunized. immunized. Supply-side issues, notably the dearth of health care workers in the primary health care system, 50% of children 0–6 months are are a key challenge in the state. There is also exclusively breastfed. a need for stronger political commitment to improving health care in the state. OYO STATE GOVERNMENT ACCELERATED ACTION FOR IMPACT: Improving maternal, newborn and child health in Oyo State AAI implementation in Oyo The Accelerated Action for Impact (AAI) “We are unhappy about this data and the number initiative was launched in Oyo in July 2018 of children dying in Oyo State. We would work with under the leadership of the Honorable UNICEF to ensure things change and our children Commissioner of Health and has been stop dying.” – Honourable Commissioner of Health, contextualized to the needs and priorities of the Dr Azeez Popoola Adeduntan state. AAI APPROACH APPLICATION IN OYO EXAMPLES OF PRACTICAL ACTIONS Ensure clear state- • Oyo State primary health care • AAI technical working group and relevant led leadership board and local government area stakeholders meet every 30 days to follow up on (LGA) chairmen are providing progress of activities; and identify bottlenecks active leadership. and address them. • Need stronger political commitment at state level. Leverage all • Resources from World Health • World Health Organization routine immunization available resources Organization and LGA chairmen intensification project microplan was updated to have been pooled to focus target hard-to-reach areas and allocate funding on intensification of routine accordingly. immunization in hard-to-reach • Chairmen released resources to procure areas of key LGAs. motorbikes so health care workers could reach facilities in hard-to-reach areas. Roll out intervention • Six LGAs in Oyo present over half • Support groups are being established in 66 packages at scale in of the maternal and child health communities from nine wards across the three targeted localities burden. LGAs to strengthen awareness and demand for • Initial focus of AAI is on the three health services. LGAs with the poorest performing • Training is planned for health care workers on indicators (Saki West, Ibarapa essential newborn care and management of North, Ibadan North-East). childhood illnesses based on the needs of each facility. • Cold chain for immunizations is being assured through solar energy solutions in all health facilities that provide immunization in focus LGAs. Ensure inclusive • Communities and facilities are • Together with the National Orientation Agency, engagement with working together to develop community dialogue activities were held which communities and solutions to jointly identified assisted in diagnosing bottlenecks and gaps in health care workers bottlenecks. primary health care. from the bottom up • Linkages between facilities and communities have been strengthened in the focus LGAs. Coordinate with • Efforts are being made to enhance • AAI progress meetings include the attendance of all development multisectoral coordination around relevant ministries, departments and agencies, partners in support health issues in the state. and their inputs and engagement are increasing. of one state-led plan 2 ACCELERATED ACTION FOR IMPACT: Improving maternal, newborn and child health in Oyo State From data to action to impact in Oyo: Routine immunization Community volunteers WHY? ANALYSE THE capacitated to sensitize clients PROBLEMS AND GAPS and improve linkages to facilities. REVIEW AND REVISE: WITH ALL STAKEHOLDERS Chairmen of two LGAs with TRACK PROGRESS AND hard-to-reach areas have ADJUST AS NECESSARY Demand side: Lack of trust in procured motorbikes for health health care system, perception care worker access. AAI inception numbers of of poor quality of care and poor Cold chain monthly review unimmunized children Only 37% of children in Oyo attitude of health care workers. meetings to support bottom-up decreased by 50% in Saki were fully immunized in 2017. Supply side: Hard-to-reach solutions tailored to each facility. West and 10% in Ibarapa Wide disparity across the areas are inaccessible for Solar direct drives being supplied North. state, with hard-to-reach health care workers during the to facilities in focus LGAs to Ibadan North-East now has areas performing more poorly. rainy season. ensure cold chain. The cold chain is not secure for the lowest number of unimmunized children. WHAT IS GOING ON? vaccines. TAKE ACTION: TARGET START WITH THE DATA CHALLENGES WITH AND GO GRANULAR HIGH-IMPACT INTERVENTIONS Leveraging what works to pool resources for highest- burden communities “I will work with my LGA councillors and ensure they work with the religious leaders in addressing fundamental cultural issues impacting health.” – Honourable Nathaniel Akano, Chairman Saki West LGA © UNICEF T O L Top it up with a S Identify new action Leverage what opportunities OYOSHIA is taking steps to Strengthen the is working upgrade, renovate, staff and AAI data-driven approach foundation procure commodities for Oyo State Health Insurance was used to help the improved service delivery at AAI is strengthening Agency (OYOSHIA) is OYOSHIA determine where primary health facilities in coordination of all state committed to improving and on what they should the focus LGAs. actors (MDAs) and partners health care in the state and focus their attention, working on health (Ministry employing innovative resources and support. of Health, Primary Health strategies towards funding Care Board, OYSHIA, and partnering. National Orientation Agency, World Health Organization, private sector). 3 ACCELERATED ACTION FOR IMPACT: Improving maternal, newborn and child health in Oyo State Concrete changes at facility and community levels “UNICEF has given us the wheels to reach the children in Okerete [a very remote community in Saki West]. We are committed to doing everything within our power to reach them.” – Dr Jola-Moses, Medical Officer of Health, Saki West LGA Next steps • Continue recruitment and training of addressing human resources for health care workers across Oyo State health gap in the focus LGAs. to address the human resource and • Ensure adequate commodities skills gap. and equipment for the health • Intensify immunization outreaches requirements of the communities and logistics support to the hard-to- across priority LGAs. reach areas, notably in Saki West and • Scale intensified AAI approach across Ibarapa North LGAs. three more LGAs, taking into account • Leverage the state health insurance the lessons learnt so far. for primary care upgrade and © UNICEF/Andrew Esiebo © UNICEF/Andrew To learn more about AAI and explore opportunities for partnership with UNICEF, please contact Dr Sanjana Bhardwaj, Chief of Health and HIV, at [email protected] or Dr Adebola Olutoyin Hassan, Health Specialist, at [email protected] UNICEF Nigeria 4.