In April 2006, CIET initiated a demonstration social audit of health service performance and information needs in Bauchi and Cross River states. 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. 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 the households interviewed said they usually used government health services; in Bauchi the proportion was 76%. Dissatisfaction and non-users were attributed to cost in both states, lack of medicines in Cross River and quality of services in Bauchi. A majority of households in Cross River (68%) and in Bauchi (60%) said that corruption was increasing.

We identified three essential benchmarks of a stronger health system:

1. Increased access: removing barriers that prevent the most vulnerable from using government health services
2. Reasonable expectations of, and satisfaction with, the behaviours of health workers;
3. Reduced out-of-pocket expenses.

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. Photos from our fieldwork and planning sessions are available in our demonstration social audit photo gallery.