Author: Dr Ezinne Peters, Health Systems Consult Limited (HSCL)
Country focus: Nigeria
Theme: Health-system strengthening
In response to Covid-19, The Resilient and Sustainable Systems for Health (RSSH) project gathered data from stakeholders and made the case to their donor that the program could continue to be effective using remote implementation.
Problem and context:
The RSSH project aims to strengthen and expand the capacity of Nigeria’s health system. The project was originally intended to be 18 months, and many of its activities relied on in-person interactions with front-line workers in health facilities.
However, due to bureaucratic challenges, the implementation timeline was shortened to 10 months shortly before the program commenced. Furthermore, around 3 months into implementation, the Covid-19 pandemic restricted in-person activities. There was uncertainty about how long these restrictions would last.
The program came to a crucial decision point following a conversation with its donor: either continue implementation in spite of existing and emerging barriers, or pause their project and therefore enable the donor to shift funds to support global health security programs.
If they were to continue, they needed to make the case that this was possible.
How did they address this gap?
In order to make the case that the project could continue to be effective remotely, the RSSH team designed a qualitative survey for 14 key project stakeholders across the 3 states.
Analysis showed people were more open to hybrid forms of implementation that they had expected. Indeed, 75% of respondents (the resounding majority) were in favor of fully remote implementation. The evidence suggested that state stakeholders were aware that health conversations might have to be deployed in a more hybrid and/or remote implementation manner, in place of the traditional in-person approach initially proposed.
What did they do with this evidence?
The team used the data from the survey to develop a Remote Work Protocol (RWP). Throughout the design, they regularly checked in with the key program stakeholders to ensure that they were in alignment with the policies and processes in development.
This RWP was shared with the prime recipient and donor for approval prior to deployment. An integral part of this RWP was ‘controlled fluidity’ in which there was greater responsibility on the states and communities to implement the plans, with flexibility to readjust budgets, timelines and implementation plans based on data that would be gathered on an ongoing basis.
In agreement with the donor, to support the shift to remote working they reprogrammed the budget to support the various states with remote working requirements (e.g. Zoom licensing). This was offset by the diminished travel budget requirement.
How did things improve as a result?
As a result of this, the project is now on schedule, within budget, and clearly meeting its overall objectives.
Indeed, the ‘controlled fluidity’ and greater responsibility provided to state and communities has seen a huge level of ownership and created a more sustainable foundation of work than would have been possible in traditional implementation plans. This approach has improved trust and boosted overall project outcomes, too.
In addition, it has built the capacity and confidence of state actors to use remote-working technologies; the processes that were instituted as part of the RSSH project can be sustained beyond solely the scope of the project, especially as the states have unlimited access to licenses and now deliberate on strategic issues remotely.
Lessons for others for using data for better decisions
- Be pro-active rather than reactive. The RSSH team were able to adjust their program successfully because of the many ways in which they were proactive. For example, when developing their RWP, they also produced a Risk Analysis Plan in which they outlined risk and response strategies to prevent and mitigate any unexpected consequences of the shift to remote working.
- Documenting events, opinions and occurrences as they happen can build a valuable pool of evidence that can later be used to make the case for why or why not to proceed in a certain way.
- Leverage existing relationships and ensure that stakeholders are involved at every phase. By involving stakeholders very early in the development of the RWP, the HSCL team were able to better enshrine ownership and boost acceptability when states were implementing this plan.
Where can I find more information?
Dr Ezinne Peters
Principal Technical Officer,
Health Systems Consult Limited (HSCL)
Address: Plot 856 Olu Awotesu Street, Jabi Abuja.