PRRINN-MNCH has made a significant contribution to improved maternal and child health in Northern Nigeria and has contributed to building stronger health systems and capacity in the four programme States.
The programme adopted a comprehensive health systems approach for strengthening primary health care, given the State of health systems in Northern Nigeria at the beginning of the programme. This approach allowed structural issues that were important bottlenecks for the functioning of the health system (i.e. the fragmentation of health services) to be addressed, as well as developing key systems and processes essential to a well-functioning health system (i.e. health information systems, drug supply, rehabilitation of infrastructure, human resources).
Despite these achievements, not all programme targets at outcome level were attained and there is still a large gap to enable adequate coverage for key maternal and child health interventions in the programme States. Less than 20% of children in project areas are fully immunized by their first birthday and vaccine stock outs persist at national, state and facility level. Half of pregnant women do not currently receive ANC, seven out of ten pregnant women are still delivering at home, and access to emergency obstetric care, as reflected by the Caesarean section rates, is very low. Access to family planning is also very low, inadequate to impact significantly on maternal mortality rates.
These indicate the need to scale-up efforts towards MNCH and a need to go deeper and broader to reach a larger population and achieve higher coverage of MNCH services to further impact maternal and child morbidity and mortality. The appropriate balance needs to be struck between federal level engagement and broader health system strengthening work, and activities to improve service delivery and increase demand for MNCH and RI services. The new MNCH2 programme should be designed cognizant of these issues.
PRRINN-MNCH should work closely with MNCH2 during the transition period to ensure a firm understanding of how PRRINN-MNCH has been working within each State and nationally, and an understanding of how the successes of the programme can be continued.