Although an evaluation of the outcome of MNCHW in Nigeria did not show a significant improvement in the coverage of the essential package of the MNCHW program in Nigeria, government officials have stated that it has been pivotal in improving the health of women and children in Sokoto State. The biannual campaigns increase the uptake of key public health interventions in the campaign package of services (outlined above). Akwa Ibom State also reports positively about MNCHW.
The bundle approach of providing multiple health interventions during the MNCHW reduces logistical costs, maximizes outreach, and enhances service coverage. In particular, the integration of services such as HIV testing into MNCHW is an effective strategy for increasing case finding and linkage to the Prevention of Mother-to-Child Transmission (PMTCT) and for increasing the number of birth registrations for children.
The monitoring team is composed of officials from the Sokoto State Ministry of Health, the State Primary HealthCare Development Agency, and implementing partners. A monitoring checklist was developed before the campaign. We administered the checklist to selected stakeholders involved in the campaign. We also conducted key informant interviews with key state officials and health workers to get deeper insights into the MNCHW in the state. Exit interviews were conducted with caregivers to assess their knowledge, attitude, and practice of the campaign.
Officials and health workers at the state and LGA levels demonstrated commitment to driving the success of the campaigns during the week. At the end of each day’s monitoring exercise, all the monitors and state officials convene in a “situation room” to review the day’s campaigns across the state. We discussed successes and challenges (including how we overcame them) and proffered solutions to improve the next day.
There was adequate availability of health commodities during the week. I must commend the efforts of the Sokoto State government and the partners supporting the state for ensuring the availability and timely delivery of a significant amount of health and nutrition commodities to the health facilities before the start of the MNCHW. Additionally, most of the commodities were properly stored under optimal conditions.
Challenges
Inadequate funding
The MNCHW was mostly funded by donors and implementing partners. This challenge is not limited to Sokoto State; many states experience a similar problem. There is typically very minimal government funding, which makes sustainability and ownership of the campaigns difficult. Reliance on external funding underscores the need for increased government commitment and innovative financing mechanisms.
Poor stakeholder coordination
The monitoring teams comprise several representatives of different partners who join the state officials to visit a PHC. There was a prior grouping of where each person went, according to LGAs; however, there was no assigning of specific PHCs per person. Hence, there were duplications of visits to the same health facility by different monitors for the same partner. This culminated in two to three monitors visiting the same health facility, sometimes on the same day. This potentially overwhelmed the health workers and resulted in the duplication of limited resources.
Lack of birth registration services
Integrating birth registration services during the MNCHW is an effective strategy to improve the children’s coverage for birth registration. At the time of the MNCHW, no PHC recorded a birth registration. This was due to the inadequate staff of the National Population Commission to provide the service during the week. It was indeed a missed opportunity for the unregistered children.
Coverage gaps
The coverage for reproductive, MNCH, and nutrition services is not optimal at any given time during the week. Despite targeting marginalized groups, many rural and hard-to-reach areas report suboptimal service coverage due to logistical constraints and staffing shortages. Another key barrier to access to health services in Sokoto State is the issue of banditry and kidnapping in some LGAs. This affected the conduct of campaigns in those LGAs. To bridge this gap, state officials planned to conduct mop-up campaigns at some targeted communities to ensure they receive the package of health services.
Poor social mobilization activities
The inadequate funding affected the development of Behavior Change Communication (BCC) materials and community mobilization. Many caregivers I interviewed were unaware of the MNCHW and its benefits. In communities where announcements were made before the MNCHW, it was once insufficient to mobilize a community to come out in large numbers to access health services.
The Way Forward
The MNCHW can be impactful if the state government provides sufficient funding to match the partner funding. Evidence-based micro-planning should guide resource deployment, prioritizing high-burden and underserved communities. Social mobilization activities should be adequately planned, funded, and implemented in the communities to increase demand for the services provided during the week.
Engaging local influencers and leveraging community cultural and religious structures can enhance participation and sustain behavioral change. While MNCHW is an effective strategy to increase coverage for high-impact public health interventions, a streamlined monitoring and evaluation framework can ensure real-time data utilization for decision-making.
The MNCHW reaffirms that integrated health campaigns bridge service delivery gaps and foster community trust in public health systems, especially when well-funded and fully implemented. By addressing implementation challenges and scaling successful strategies, MNCHW campaigns increase the coverage of high-impact, cost-effective public health interventions that contribute to the health of women and children in Nigeria.