Evidence for action (E4A) seeks to improve maternal and newborn survival through a combined focus on evidence, advocacy and accountability in Nigeria and two sub-Saharan African countries. One of its interventions is the strengthening of Maternal and Perinatal Death and Surveillance Response (MPDSR) in Lagos State, Nigeria. The MPDSR is a qualitative, in-depth investigation into the causes of, and circumstances surrounding maternal or perinatal deaths that occur in health facilities. In May 2017, this paper-based process was digitized to improve the quality of maternal and newborn health services and outcomes in Lagos State.
E4A commissioned LAMP to conduct a Social Return On Investment (SROI) evaluation of the digitization of the Maternal Perinatal Death Surveillance and Response (eMPDSR) system in Nigeria. SROI is a framework for measuring and accounting for the broader impact of an intervention. It involved evaluating the digitization of the MPDSR based on opinions of key stakeholders and analysis of expected outcomes. During the study, stakeholders were identified, outcomes were mapped, these outcomes were evidenced and given a value, the impact of the intervention was established and the SROI ratio was calculated. The SROI methodology was used because it captures the range of opinion from different stakeholders that have been involved in the implementation of the digitization process.
Voices for Change (V4C) created space and opportunities for adolescent girls and young women to grow, speak up and speak out. Engaging men and boys in the process, they hope to create “new ways to change behaviour”, contributing to a Nigeria where every girl and boy, woman and man, achieve their full potential. LAMP provided support to V4C to strengthen internal processes for routine monitoring and reporting of VfM. This included revising templates for analysis, conducting training for staff and facilitating Value for Money assessments. The end of programme assessment conducted in 2017 included lessons learned on application of VFM during implementation. Findings from the final year VfM analysis were published here.
LAMP was commissioned by WHO to undertake a cost outcome assessment of the hard to reach (HTR) maternal newborn and child health (MNCH) programme in six States in Northern Nigeria. The $28m programme was funded by Bill and Melinda Gates Foundation (BMGF) and was implemented by WHO and UNICEF in Kaduna, Kano, Katsina, Bauchi, Yobe and Borno. The programme aims to improve quality of life for women and children through the strengthening of health systems in North Nigeria. An economic evaluation was undertaken to determine the overall value for money of the HTR/MNCH programme.
A case-study approach was used to investigate Value for Money within two different programmes implementing post-natal care (PNC) services for women and children in Sierra Leone. The two programmes are funded by UK Aid as part of the Integrated Reproductive, Maternal, Neonatal and Child Health (IRMNH) programme. The analysis examined the impact of each programme in terms of targeting women and children and uptake of PNC services. It also looked at Value for Money at each stage of the results chain and investigated opportunities to improve effectiveness and efficiency within each intervention.
In Kenya, LAMP produced a Value for Money Analysis for the Adolescent Girls Initiative Action Research Programme (AGIARP). AGIARP aims to improve the lives of adolescent girls in Kenya by improving their access to health, education, economic assets and protection from violence. LAMP’s analysis compared VfM aspects across three implementing partners of AGIARP. LAMP also developed a template for quarterly reporting to DFID. LAMP then produced a set of recommendations on how AGIARP can incorporate VfM to a greater extent within their programme.
In Kenya, LAMP conducted a Value for Money analysis of KEEP, a DfID funded, multiple-partner education programme which subsequently received an award for ‘Best VfM Analysis’ by DfID Kenya. Working with our client, we developed a VfM approach which can continue to be applied in the future, as well as comparing the cost-effectiveness of different interventions aimed at increasing access to education and improving learning outcomes. Our approach used standard indicators for internal programme comparisons, benchmarking information from other similar projects in Kenya and relevant international comparators. Capacity building of implementing partners was included alongside the analysis.
In June 2016 LAMP was asked to build on the work conducted in the interim analysis to prepare a final value for money analysis of KEEP. Undertaken at the end of the programme and with access to more outcome level data the final report focused more on the effectiveness and cost effectiveness of the programme. It also examined VfM with respect to KEEP providing evidence-generating interventions as well as service-delivery programmes. Additionally, the report explored themes of equity and sustainability. The final report included a detailed analysis of 16 implementing partners across multiple interventions. Unit costs of key interventions such as school renovations and cash transfers were benchmarked against comparators to inform the assessment of VfM. The report presented findings alongside a set of practical recommendations to promote VfM in the future.
LAMP worked closely with KEEP’s management team and DfID Kenya to challenge and validate the findings, and to critically assess what was of most importance to both policy makers and implementers in order to maximise the learning value of the VfM analysis.