2019 Nigeria Verbal and Social Autopsy Study
Dr. Michael Kunnuji
2019 VASA Lead Qualitative Researcher, CIRCLE
USAID and the CIRCLE project supported the National Population Commission to conduct the Nigeria 2019 Verbal and Social Autopsy (VASA) study to determine the causes of under-five deaths as a follow-up to the 2018 Nigeria Demographic and Health Survey (NDHS)1. The 2019 VASA surveyed 3,200 caregivers of children under-five reported to have died in the five-year period preceding the NDHS, and sought to document contextual factors implicated in these deaths.
Nigeria’s neonatal and under-five mortality rates of 39 and 132 per 1000 live births1, which translate to about 858,000 deaths annually, are the highest in the world2. The 2019 VASA found the main causes of neonatal and child deaths to be as follows3:
The study also documented barriers to accessing formal healthcare services which included: erroneous health beliefs, distance to facilities and poor infrastructure, cost of accessing care, insecurity and perceived low quality healthcare services. To learn more about the 2019 VASA findings and access all related products, see here.
In order to reverse the current trend in Nigeria’s under-five health outcomes, it is important to take the findings to those who can make a difference through policies, programs and behavior change.
The national dissemination events, held in Abuja November 5-10, began with a journalist workshop aimed at helping media professionals make sense of the results for reporting without misrepresentation of facts. Many journalists described the findings as eye-opening, enlightening, and informative. Some were dismayed, however, by the number of child-deaths recorded in the country and Nigeria’s slow progress. When asked about what action they were likely to take, the participants said they would use the lessons learned to improve their reporting of child health-related matters. Participants expressed a determination to use their role in advocacy and public sensitization activities to get the government to commit resources to improving the health system and address misconceptions on child healthcare in Nigeria. Following the event, several of the journalists published articles about the key findings in national newspapers (see articles here: 1, 2, 3).
At the national seminar, the Honorable Minister of Health, Dr. Osagie Ehanire, and the Honorable Minister of State for Health, Dr. Olorunnimbe Mamora, launched the reports, acknowledging “the sound collaboration of several organizations with the National Population Commission, including the Federal Ministry of Health and Development Partners, led by USAID.” He called on Federal, State, and Local Government agencies, as well as the private sector and civil society organizations, to “make use of the 2019 VASA data for planning and development purposes.” These words were encouraging and created the right momentum to use evidence-based programming to address Nigeria’s under-five mortality problem.
A data users’ workshop followed the national seminar. This workshop convened government officials to discuss how data from the 2019 VASA could influence existing child health-related policies. The exercise further deepened stakeholders’ understanding of the findings and how to put the results to use in their different units and departments. In addition to the top Health Ministry-level, this resolve was voiced by federal government officials, as well as health program implementers. Their reflections at the workshop will further influence better focused program design and implementation in the country.
After the national launch, findings were also disseminated through events in the six geo-political zones of the country in mid November. The zonal disseminations were attended by senior state government representatives from the Ministries of Health, Women Affairs and Social Development, and other relevant ministries, and development partners operating within the zones. I attended the North West dissemination in Kebbi State where participants described the results as valuable data for designing programs.
“This becomes the baseline for our programs and in the next two to three years, we will conduct another study to see what progress we have made.” Permanent secretary, Kaduna State
The North West participants found that the VASA results helped them to interpret why the zone’s high rate of child deaths existed and how to develop policy and program actions to address them. Participants suggested that the development of an accountability framework and better policy implementation within the health sector can help improve child health outcomes. They agreed that a way to ensure that the problem gets the attention it deserves is for the results to be presented at the Northern Governors’ Forum since the Northern states together account for 80 percent of the deaths investigated. It is believed that getting the attention of governors is key to solving the problems of weak health systems and poor infrastructure at state levels, since they interact with technical, as well as resource and financial administrators.
At the North East dissemination in Gombe State, policymakers and program implementation partners stressed the need to take the findings to the relevant departments and local government level. Presenting the reports to the State’s Budget Advisor can provide important context by ensuring that budgetary allocations are made to address the needs of the health system. Participants also explained that the study provides development partners with documents that clearly show what needs to be prioritized as they can focus on key issues raised in the reports. Participants also resolved to prioritize addressing the problems of the girl child’s education, child marriage, and empowering households as they are key to reducing under-five deaths in the zone. The North East stakeholders suggested the introduction of a Health Trust Fund to raise and manage funds to address some of the problems identified in the report.
In summary, the dissemination of the 2019 VASA findings enabled key stakeholders understand the severity of under-five mortality, and helped to catalyze and compel them to act on these serious issues. With the contextual data about mortality causes and findings, they expressed that they are now better equipped to take on this challenge. Given the entire process of engaging stakeholders to implement the 2019 VASA (learn more here), and the recent disseminations, I have hope that the data will be used to improve Nigeria’s response to the problem of under-five deaths.
1National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. https://dhsprogram.com/publications/publication-fr359-dhs-final-reports.cfm
2United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME), ‘Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2020. https://www.unicef.org/media/79371/file/UN-IGME-child-mortality-report-2020.pdf.pdf
3National Population Commission (NPC) [Nigeria] and CIRCLE, Social Solutions International, Inc. 2020. Nigeria 2019 Verbal and Social Autopsy Study: Main Report. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and Social Solutions International, Inc. https://drive.google.com/file/d/1-kJyr81BTejkayBy2vYnXSRCjrgKZEXi/view