Authors: The Challenge Initiative team: Lekan Ajijola, Victor Igharo, Nneoma Anieto, Lisa Mwaikambo
Theme: System-level change
The Challenge Initiative (TCI) uses responsive feedback to strengthen State Government’s Responsiveness to Family Planning Programming in Nigeria. Specifically, they created a special tool to embed responsive feedback. The Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool reviews government performance against key indicators and identify areas where they can co-develop prompt course corrections. By doing so, they reduced the risk of strategic and operational gaps in government programming and increased government ability to sustain the interventions.
Government ownership and sustainability of health programs is still a challenge in low- and middle-income countries, including Nigeria. There is weak local government self-reliance to scale up family planning (FP) and adolescent and youth sexual & reproductive health (AYSRH) high-impact interventions. Sustained improvements in urban health systems are impeded as a result as well as increased use of modern contraception, especially among the urban poor.
The RAISE tool:
The Challenge Initiative looked to address this issue by creating and using a special tool – the RAISE tool – to encourage governments to evaluate and reflect on their self-reliance. The tool uses many sources of data including project records, and budget tracking reports to score state governments as ‘Beginning’, ‘Developing’, ‘Expanding’ or ‘Mature’ in terms of their progress towards self-reliance related to FP programming.
Using the state score, TCI co-design and develop ways to improve state government self-reliance in family planning programming as well as overall family planning performance.
Example in action:
Findings from early RAISE tool assessments graded several states as ‘Developing’; they had a basic level of government systems and processes for program sustainability. RAISE findings and feedback were provided to the extended government FP teams during quarterly FP technical working group meetings for policy makers and technocrats.
Subsequently, the TCI team engaged government stakeholders through participatory stakeholder workshops to reflect on the findings and co-develop plans to improve RAISE scores. Some of the gaps identified were a “lack of funding for Social & Behavior Change (SBC) interventions”, “inconsistent data at the facility, local government and state levels”, and “weak community to facility referrals”.
Subsequently, government programs were redesigned to include coaching of community & facility health providers on effective two-way referral systems; and community social mobilizers were deployed to support client referrals and follow up services.
Overall, annual state program designs and operational plans now integrate social & behavior change and AYSRH interventions more visibly to enable government team to prioritize funding for them.
This brilliant use of responsive feedback enhanced program effectiveness in three ways.
- It improved government capacity to lead and facilitate implementation of high-impact interventions;
- It encouraged adoption and scale up of high-impact interventions to more local government areas within each state;
- It increased government funding for family planning including SBC & AYSRH programs.
This has moved several states supported by TCI to the ‘Mature’ stage demonstrating stronger self-reliance in FP programming. The few remaining states are currently in the ‘Expanding’ stage gradually moving towards program maturity.
TCI has now developed a National RAISE dashboard to track progress towards government self-reliance across supported geographies and help inform real-time decision-making. The RAISE tool’s structured and participatory process allows local governments to self-assess their FP program (with support), track progress and make smarter decisions related to their FP program.
Lessons for others:
- Work with what you have. Responsive feedback does not necessarily require new data to be collected. Instead, organizations can draw more value from their existing data through consistent and regular review of a select number of priority indicators. Learn more by reading The Data Curve handbook, which you can find in the Resources section of our website.
- Establish an open culture of learning. The TCI team took time to ensure that government stakeholders did not feel that their performance was being reviewed for accountability or blame purposes. Instead, they fostered an open environment and blame-free culture that allowed everyone to objectively speak about areas for improvement and learning, without being made to feel that they were being judged for their performance. Learn more by reading How to Build a Culture of Learning handbook, which you can find in the Resources section of our website.