FACULTY OF PUBLIC HEALTH

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    Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study
    (Springer Nature, 2021) Oluwasanu M. M.; Adebayo, A. M.; Okunade, F. T.; Ajayi, O.; Akindele, A. O.; Stanback, J.; Ajuwon, A. J.
    Background: The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods: The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results: The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion: PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.
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    PROCESS EVALUATION OF BEHAVIOUR CHANGE COMMUNICATION MATERIALS DEVELOPED AND UTILIZED FOR HIV PREVENTION BY NON-GOVERNMENTAL ORGANIZATIONS IN OYO STATE, NIGERIA
    (2013-06) BOLARINWA, K. K.
    Public health education is a major strategy for controlling the spread of HIV. An important component of this strategy is the effective utilization of well-designed Behaviour Change Communication (BCC) materials. The Oyo State World Bank-assisted HIV and AIDS programme funded 40 Non-Governmental Organizations (NGOs) from 2006 to 2008, to produce BCC materials to reach target audiences. However, the process evaluation of the development of the materials in line with the WHO model has not been systematically conducted. This study was therefore designed to assess the level of adherence by these NGOs to basic standards in the process of development of the BCC materials. The study was a descriptive cross-sectional survey. Balloting was used to select 20 out of the 40 funded NGOs. The NGOs were categorized into five equal groups based on target audience that is; Female Sex Workers, Mission Birth Attendants, In-school Youth, Women and People Living with HIV. A checklist was used to assess compliance with each of the following seven stages of educational materials development in line with the WHO model: Needs Assessment (NA); message conceptualization; design; pre-testing; production procedure; implementation and outcome evaluation. In-depth Interviews (IDIs) were conducted for the twenty NGO project coordinators while one Focus Group Discussion (FGD) was conducted among each of the five target groups. Descrptive statistics was used to analyze quantitative data while the FGD and IDI data were transcribed and analyzed using thematic approach. Only two out of twenty NGOs complied with all the seven stages of WHO model of BCC material development. All the NGOs conducted NA and material design, 95.0% carried out implementation involving target audience and 85.0% conducted outcome evaluation of the materials. Eighty percent pre-tested their materials, 65.0% conceptualized communication messages while 25.0% of the NGOs involved target audience in the production procedure. Some (40.0%) project coordinators had one form of training or the other on BCC material development while 60.0% had no training. Only 35.0% conducted training for their target audiences before distributing the materials. Weak technical capacity in BCC material development was a major challenge as reported by the project coordinators. The FGD findings corroborated responses from the IDIs that target audiences were involved in NA, pre-testing and material distribution but not in message conceptualisation, production procedure and outcome evaluation. Adherence to basic standard process of developing Behaviour Change Communication material is low among the Non-Governmental Organizations assessed. An intervention comprising training and supportive supervision is needed to enhance the skills of project coordinators in the development of behavioural change communication materials.