Determinants of effectiveness of a novel community health workers programme inimproving maternal and child health in Nigeria. (360G-Wellcome-106530_Z_14_Z)

The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be done by investigating two implementations (with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will: 1. Understand of the context and the process of implementation of the interventions; 2. Identify, assess and compare the intervention outputs and outcomes; 3. Develop a model of complex relations between the actors, context, implementation process, outputs and outcomes of the interventions; 4. Develop transferable best practices for scalability and generalizability of the interventions. This five-year study will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, identified in consultation with the Federal MOH and SUREP national programme officer. The project is designed as a multidisciplinary and mixed methods study, using qualitative and quantitative methods. Realist evaluation will be an overall platform for the study, which will use economic evaluation, social sciences and statistical analysis. Qualitative data will be collected using in-depth interviews with facility managers, community health workers, PHC staff; facility exit interviews and focus group discussions with service users and their families. Quantitative data will include existing data from HMIS and SURE-P programme and structured facility exit survey with pregnant women. Analysis of quantitative and qualitative datasets will be integrated, to allow in-depth exploration of emerging issues and continuous triangulation of findings. Project results will be disseminated widely through development of policy briefs, presentations at management meetings, newsletters and press-releases, to ensure their uptake in policy and practice in Nigeria and wider.