‘A seamless transition’: how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria

Abstract

Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme’s sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents’ accounts, six key actions emerged as essential in promoting the VHW Scheme’s sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial.

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Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study

“…Components aimed to enhance uptake and provision of life-saving interventions at three interacting levels (individuals and families; community organisations; and the health system). At the individual and family level, interventions aimed to improve knowledge, attitudes and practices to increase enhanced home-based practices and increase demand for routine professional care; for example, a community-based village health worker home visit scheme was initiated to improve knowledge about and linkages between families and health services 33. At the community organisation level, interventions aimed to improve trust and accountability between the family and health system levels; for example, through supporting community-based mothers groups to interact with their local primary health services 34.…”

“…At the individual and family level, interventions aimed to improve knowledge, attitudes and practices to increase enhanced home-based practices and increase demand for routine professional care; for example, a community-based village health worker home visit scheme was initiated to improve knowledge about and linkages between families and health services. 33 At the community organisation level, interventions aimed to improve trust and accountability between the family and health system levels; for example, through supporting community-based mothers groups to interact with their local primary health services. 34 Interventions at the health system level aimed to improve the supply of safe, effective and high quality care; for example, working with government to strengthen the supply chain for essential drugs in PHCs.…”

Sustainability of Donor-Funded Health-Related Programs Beyond the Funding Lifecycle in Africa: A Systematic Review

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