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Quantitative Survey – Results Report Report to Women for Health Quantitative Survey – Results Report Beyond Graduation: Understanding how women and communities have changed as a result of W4H and exploring the remaining challenges faced by women health workers in Northern Nigeria 0991-7-G-NT-5-4-04 Lauren Haddon June / 2020 No 1 Adamu Dankabo Close, Off Tukur Road, Nassarawa GRA, Kano, Kano State For more information: www.women4healthnigeria.org Connect with us: twitter.com/@W4HNigeria facebook.com/women4health.DFID/ 2 Final Approval Report Approved and Signed off by: Adetoro Adegoke 27th July 2020 AA Contents Abbreviations and Acronyms ...................................................................................................... 3 SECTION 1 – EXECUTIVE SUMMARY ................................................................................. 4 SECTION 2 – MAIN REPORT ............................................................................................... 6 2.1 Introduction ................................................................................................................... 6 2.1.1 Background ........................................................................................................... 6 2.1.2 Objective ............................................................................................................... 7 2.2 Approach & Methodology .............................................................................................. 8 2.3 Analysis and Findings ................................................................................................... 9 2.3.1 How has the FYP and W4H interventions with HTIs impacted the number of health workers in Northern Nigeria? ............................................................................................... 9 2.3.2 How have the FYP and W4H interventions with HTIs impacted the empowerment of women and women health workers in particular in Northern Nigeria? ................................ 23 2.3.3 What elements of the W4H approach could be strengthened to reinforce its effectiveness when adopted by States? ............................................................................. 27 2.4 Conclusion .................................................................................................................. 36 SECTION 3 – ANNEXES ..................................................................................................... 38 Annex 1 Terms of Reference .......................................................................................... 38 Annex 2 Survey Questionnaires ..................................................................................... 49 3 Acknowledgements The consultant is grateful to the following for their assistance in the production of this report: Name Position Organisation Dr Fatima Adamu National Programme DAI Global Health Ltd. Manager Dr Adetoro Adegoke Lead Senior Technical DAI Global Health Ltd. Advisor Chinny Ogunro Quantitative Consultant Independent Consultant Nasiru Sa'adu Fakai MEAL Advisor DAI Global Health Ltd. Miniratu Soyoola Lead researcher DAI Global Health Ltd. Georgia Taylor Gender Advisor DAI Global Health Ltd. The contents of this report are the sole responsibility of its authors and do not necessarily reflect the views of DAI Global Health, Save the Children, or the UK Department for International Development. Abbreviations and Acronyms DFID UK Department for International Development HTI Health Training Institution FMOH Federal Ministry of Health FYP Foundation Year Programme MOH Ministry of Health NMNC National Midwifery and Nursing Council SBA Skilled Birth Attendant SCL Student Centred Learning UHC Universal Health Coverage W4H Women for Health 4 SECTION 1 – EXECUTIVE SUMMARY The W4H programme has over the years produced considerable evidence that demonstrates how the programme has resulted in: • an increase in the number of trained female health workers who are deployed to the rural areas, • strengthened health training institutions (HTIs) so that they gain and maintain accreditation, become more autonomous, accountable and equitable, and ultimately provide better quality teaching and learning; and • the empowerment of female tutors, women in leadership positions, and young women students from rural communities who intended to train and work as health workers. These data collection exercises have however been limited, with most of the outcomes channelled for advocacy and knowledge management rather than research. As a result, this research, tagged “Going Beyond the Training and Graduation of Health Workers” was commissioned by the W4H programme in December 2019. The research focuses on four areas of inquiry - health worker recruitment and retention; women’s empowerment; provision of quality health services to women; and women’s ability to access healthcare services – and has been structured in two distinct components – a quantitative data collection through a tracer survey and analysis of the HRH registry data and a qualitative data collection through a community case study approach. This report focuses on the results from the quantitative data collection. Four core datasets were analysed as part of the quantitative research: • the registry of health workers data collected in 2019 by or with the support of W4H • the Nigeria Demographic Health Survey 2013 and 2018 • graduate tracer survey of HTI graduates from 2014 to 2019 • survey of women who only passed through the Foundation Year Programme (FYP) and who did not continue on to be health workers (“FYP at home”). The research quantitative survey results presented in this report overwhelming support the W4H’s Theory of Change premises. From the analysis of the health worker registry, 1,133 respondents from the Graduate Tracer Survey and 222 respondents from the “FYP at home” survey, this research was able to determine that: 1. There was an overall increase in health worker numbers across the five W4H States 2. The FYP and advocacy interventions increased the number of female rural health workers 3. Both FYP students and HTI graduates reported positive changes in women’s economic and social empowerment within their families and communities as a result of their participation in the FYP and / or attendance at HTI to further their education Challenges nevertheless remain including: 1. Despite the significant increase in health workers employed, Northern Nigeria still has a significant gap in average number of health workers as compared to the national average 2. The continued commitment from state governments to increase the number of graduates employed as health workers is crucial 5 3. Long-term bedding in of changes observed at community level through continued support to the community engagement approaches of W4H will ensure that the observable changes in norms, attitudes and behaviours towards women are sustained 4. Further research required on whether the W4H interventions also have an impact on the long-term retention of female health workers in their rural postings and whether they influenced long term employment prospects of supported students. 6 SECTION 2 – MAIN REPORT 2.1 Introduction 2.1.1 Background The UK aid-funded Women for Health (W4H) programme has been working since November 2012 to improve the number and capacity of female health workers in five states in Northern Nigeria (Kano, Katsina, Jigawa, Zamfara and Yobe) while at the same time contributing to women’s empowerment and gender equality in communities and institutions in the North. The programme responds to a severe shortage of female health workers in a region where there are social and cultural barriers to women being seen by male health workers. It is expected that the increase in female health workers will lead to an increase in women’s access to, and utilisation of, health services in Northern Nigeria to increase the delivery of Universal Health Coverage (UHC). During the first five years of implementation, W4H achieved a wide range of successes across several areas: increasing the physical, management and teaching capacity of 20 Health Training Institutions (HTIs); improving quality of teaching and supporting HTIs to transition to a Student Centred Learning (SCL) approach; introduction of a Foundation Year Programme (FYP) for rural women to improve their academic credentials, study skills and confidence to enter health worker training; community engagement in more than 912 underserved communities to promote positive attitudes towards, and community sponsorship of women attending tertiary education, and becoming health workers; and engagement with government to ensure commitment, legislation and budgeted funding to sustain HTIs and FYP activities into the future. During the programme’s no cost extension phase, inception activities for Borno state were concluded. This provided an enabling environment for the costed extension phase between April 2018 and October 2020 (“Phase 2”). During this phase W4H is evolving to adapt to the emerging context and new challenges in the Northern part of the country, particularly the conflict affected states of Borno and Yobe. It is focusing on a “building back better” approach in the conflict and humanitarian areas in Yobe and Borno states and ensuring sustainability of the progress achieved over the last five years in Katsina, Kano, Jigawa and Zamfara. The extension phase is also facilitating locally led scale up of the W4H approach in additional states and institutionalisation of commitment by federal agencies. It is expected that
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