Tellison Osifo Ojogun*, Inuwa Bakari Jalingo*, Robinson Daniel Wammanda**, John Quinley** and Ana Claudia Franca-Koh**
*National Population Commission; **USAID Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) project
Nigeria has the world’s second highest mortality rate of children under five years old and the world’s second largest number of under five deaths.1 According to the 2018 Nigerian Demographic and Health Survey (NDHS) there are 132 deaths for every 1,000 births.2 Efforts to prevent these deaths depend on Nigerian policy makers, program managers, and care providers funding and implementing high impact interventions.
Following the recent 2018 NDHS, the National Population Commission, in collaboration with the Federal Ministry of Health, with assistance from the U.S. for Agency International Development (USAID) Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) project, began the implementation of a verbal and social autopsy (VASA) study in 2019 to identify the main causes of under five deaths in Nigeria. This study will provide data on the causes of under-five deaths in Nigeria (verbal autopsy) and the social context and healthcare responses that preceded these preventable deaths (social autopsy). Combined, the results of the VASA study can provide a compelling narrative on why Nigerian children die and to inform strategies and target actions to address preventable deaths.
Data collection for the Nigerian 2019 VASA study was completed in December 2019 and analysis is underway. From the results of the 2019 VASA study, the government of Nigeria and other stakeholders will develop and adopt health service plans and strategies that will help improve the health of children and reduce mortality rate. However, this action is dependent upon the involvement of country stakeholders in both the processes of data collection, analysis, and agreement on action.
A “Technical Sub-Committee on the 2019 VASA” was formed under the National Population Commission/Federal Ministry of Health Steering Committee for the Nigeria 2018 Demographic and Health Survey (NDHS). This provided a platform to involve key stakeholders. Members include:
- Offices in the Federal Ministry of Health (Department of Planning, Research and Statistics, Family Health Division; National Malaria Elimination Programme);
- National Primary Healthcare Development Agency;
- National Population Commission as the implementer;
- U.S. Agency for International Development as the funding and technical assistance partner through the CIRCLE project;
- Representatives of professional bodies (Pediatrics Association of Nigeria – PAN; Nigerian Society of Neonatal Medicine – NISONM; and the Society of Obstetrics and Gynecology of Nigeria – SOGON);
- Representatives of five universities with strong academic medical programmes; and
- Other relevant ministries (National Bureau of Statistics, Ministry of Women and Social Development, Nigerian Governors’ Forum Secretariat).
If users have faith in the content [of the VASA], the tendency is for them to spread the news that this is what went into it and we believe in the quality of that data. So you realize that their [the stakeholders] participation from the beginning, apart from adding value, also stems into ownership of the whole document in the long run and the tendency for use is going to be higher than it would have been if they didn’t know the processes and procedures that led to the data being collected.”
– Tellison Osifo Ojogun, Project Director, National Population Commission
This group has already met three times to review data collection tools and guide the VASA process.
In addition, there is an extended stakeholder group involved through briefings and periodic emails. This group includes representatives of government agencies (Nigerian Centre for Disease Control, Integrated Maternal Newborn and Child Health Secretariat), professional bodies (Nigerian Medical Association, National Association of Nigerian Nurses and Midwives, Association of Public Health Physician of Nigeria, Society for Family Health Practitioners of Nigeria), and relevant NGOs/projects working on health in Nigeria (MNCH2 project, Health Strategy and Delivery Foundation, Clinton Health Access Initiative, Integrated Health Programme).
These stakeholders will all be responsible for using the results of VASA to take action, so their participation, buy-in, and engagement in developing solutions to the issues affecting child mortality is essential.
This is a very, very great innovation as the technical working committee has been [involved] from conception, from planning, from questionnaire review. They have participated in the pilot, they have participated in the main training, and as I am talking to you, they are also on the field work. You know by the time you are involved with the process of data collection and right from the conception to the end…you find that the ownership of the output, it is your own.”
– Inuwa Bakari Jalingo, Project Coordinator, National Population Commission
Next Steps: Anticipating Data Use
Once data cleaning is completed, the Technical Sub-committee members will engage in initial analysis that will lay out the findings of the 2019 VASA during a data analysis workshop in early 2020. Members will also draft the formal survey report together and support the development of other research translation products tailored to specific audiences. The VASA findings will be disseminated at both national and zonal meetings. VASA stakeholders will also take materials to numerous national and state level policy and technical discussions.
The Technical Sub-committee members are also pursuing other opportunities to inform stakeholders that the 2019 VASA results are imminent. For example, there will be a presentation on the implementation status of the study at the 51st annual General and Scientific Conference of the Pediatric Association of Nigeria later in January 2020.
The outcome of the 2019 VASA study will provide a widely known and accepted source of knowledge in Nigeria on the causes of under five deaths. This will help in the advocacy for quality healthcare and provide guidelines to prevent further deaths.