The Better Obstetrics in Rural Nigeria (BORN) Study
Sep 15, 2015
The Midwives Service Scheme (MSS) was introduced in 2009 to increase access to skilled care for women in rural underserved areas of Nigeria. To evaluate the impact of the MSS, researchers conducted household and clinic surveys, focus group discussions and in-depth interviews, and compared changes in pregnancy and birth outcomes in MSS areas to changes in comparison areas. They found smaller than anticipated effects.
An Impact Evaluation of the Nigerian Midwives Service Scheme
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Pregnancy-related morbidity and mortality have serious economic and social consequences. The Midwives Service Scheme (MSS) was introduced in 2009 to provide round-the-clock access to skilled care in rural underserved areas of Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, the researchers surveyed 7,104 women in 386 communities across 12 states and conducted in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups in three states. They compared changes in pregnancy and birth outcomes in MSS areas to changes in comparison areas over the same period. They found a 12 percent increase in antenatal care use in program clinics and a 6 percent increase in overall use of antenatal care, both in the first year of the program. They also found suggestive but not conclusive evidence of a small increase in skilled birth attendance that was largely confined to the south where there were fewer challenges with maintaining supply of midwives. They found no improvements in maternal or child health. The researchers found that while the deployment of midwives initially increased access to skilled care, this eroded over time, potentially explaining why initial improvements were not sustained. Such problems as difficulties associated with relocating to new areas, inadequate provision of housing accommodation, and irregular payment of salaries (which worsened over time) contributed to midwives wanting to leave the scheme.
Study Findings: Impacts
Study Findings: Mechanisms of Action
Discussion and Policy Recommendations
Sample Size and Power Calculations
This work was supported by the International Initiative for Impact Evaluation (3ie) and within RAND Health, a division of the RAND Corporation.
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