Demonstration community-based social audit of health services in Bauchi and Cross River, 2006

One of the major efforts of Nigeria’s 2003-2007 National Economic Empowerment and Development Strategy was to improve the evidence available for planning health services and to create new mechanisms to generate and use evidence to support health policy and programmes.

 In April 2006, with support from the Canadian International Development Research Centre (IDRC), CIET initiated a demonstration social audit of health service performance and information needs in two Nigerian states, Bauchi and Cross River.

The aim of this pilot project was to demonstrate a tool for policy makers and donors that could improve health services quality and minimise system leakage. Objectives were to a) reveal some of the dynamics and the type of data generated by a community based social audit, b) develop communication strategies to illustrate its likely dissemination and education implications, and c) identify the capacity development and other needs of an evidence-based planning environment, focusing on linkages between data sources and planning processes, including population-weighted mapping.

 The project also sought to develop locally informed strategies for dealing with underperformance of public services, giving communities a say in the delivery of health services and enabling planners to better understand household decision-making about health and use of health services.

 We surveyed some 6,000 households in 24 clusters across Bauchi and Cross River states.

 In Cross River half of households said they usually used government health services; in Bauchi the proportion was 76%. Dissatisfaction and non-use were attributed to cost in both states, lack of medicines in Cross River and quality of facilities in Bauchi. Majorities (68% in Cross River; 60% in Bauchi) said that corruption was increasing.

 We identified three essential benchmarks of a stronger health services system:

1. Increased access: removing barriers that prevent the most vulnerable from using government health services;

2. Reasonable expectations of, and satisfaction with, the behaviour of health workers;

3. Reduced out-of-pocket payments.

 Representatives of the major stakeholders participated in feedback sessions at national and state levels.

 Summaries of key findings in Cross River and Bauchi are available from the library.

 This pilot project was part of the Nigeria Evidence-based Health System Initiative (NEHSI), a collaborative project between IDRC’s Governance, Equity and Health Programme Initiative and the Canadian International Development Agency (CIDA), with the Government of Nigeria, aimed at strengthening an evidence-based primary health system in the two states.