Implementation Process

During its first 18 months, NURHI introduced the project to the Federal Ministry of Health (FMOH), State Ministries of Health (SMOH), donors and other family planning partners.  NURHI staff became regular participants in national forums for stakeholder coordination.  NURHI staff introduced the project to key policy makers, stakeholders and leaders at SMOH, local government and community levels in each of the four first-phase cities.  Through these activities, NURHI identified pressing advocacy issues, in collaboration with its key advocacy partners:

• HERFON  – a local advocacy organization whose network of change agents advocate with government and elected officials, as well as traditional and religious leaders, on issues of health policy and reform.
• DEVCOMS – a civil society org that works with a network of journalist to focus on development and health issues in Nigeria.
• Advocacy Nigeria  – a civil society organization that advocates with religious and traditional leaders as well engages women groups at the community level to advance access to FP reproductive health and maternal and child health and gender based relations.

In addition to these local organizations, two other projects funded by the Bill and Melinda Gates Foundation, Advance Family Planning (AFP) and Futures Institute came on board to support NURHI advocacy work.

While NURHI engaged stakeholders, it also conducted formative research.  To better understand the family planning landscape in the four initial cities where NURHI works and in Nigeria as a whole, and to inform advocacy strategies, NURHI conducted several assessments during its discovery year phase  (the first 12 months of the project):

• In 2010, the NURHI team implemented a net mapping exercise at the national level and in two cities to identify key stakeholders, how they influence the family planning program, and their take on crucial challenges to the family planning program.  NURHI disseminated its findings during a one-day stakeholders meeting on World Population Day in July, 2010.
• NURHI contracted an independent consultant to conduct an assessment of resources available for family planning at State and LGA for each of the four first-phase cities, and shared results with the key stakeholders at the state and LGA levels.
• The Futures Institute and its local partner, the Association for Reproductive and Family Health (ARFH), assisted NURHI to conduct a Family Planning Effort (FPE) scoring process in each of the four first phase cities. This involved asking local family planning experts to rate four main components of their family planning programs: policies, services, record-keeping and evaluation, and access to family planning methods.  
• The Futures Institute and ARFH also conducted Key Informant Interviews on the family planning policy environment with key stakeholders in each of the four first phase cities.
• HERFON assessed the family planning policy environment among policy makers, health officials and religious leaders at state and local government levels.
• DEVCOMS conducted a rapid assessment and analysis of the family planning knowledge, attitudes, and practice (KAP) among its network of journalists in the four cities.
• Advocacy Nigeria conducted an assessment of family planning knowledge and attitudes among political, traditional, religious, and media stakeholders nationally and in the four cities.

NURHI convened a meeting of donors and critical family planning partners to discuss the national family planning program and how to move it forward.  During this meeting, stakeholders defined priority issues for advocacy at national level, and agreed that there was a need to get the FMOH to prioritize and fund family planning. Stakeholders formed the National Family Planning Action Group to influence national family planning policy implementation.

Following this meeting, NURHI participated in stakeholder meetings with the Honorable Minister of Health on how to further reposition of family planning in the national health program.   These meetings continued until November 2011, when the Family Planning Action Group in collaboration with FMOH hosted the 1^st National Family Planning Conference in 2010.

NURHI also convened meetings with family planning stakeholders in each of the four first-phase cities.  During meetings, participants identified key advocacy issues specific to their cities and formed Advocacy Core Groups (ACGs).   The ACGs comprised key stakeholders, including community members and the state government family planning coordinators and LGA FP supervisors. Each ACG serves as the think tank and helps to facilitate the development and implementation of the site-specific advocacy strategies. The ACG meets frequently (Monthly/Bi-monthly/Quarterly, as necessary) to respond to site advocacy strategy implementation and to review achievements and activities. The ACGs identified influential people in their cities who support family planning and are willing to speak publicly in its favor.  The ACGs were further trained in advocacy skills and FP messaging to enable them to become pro-active frontrunners in driving policy change and actions for improved access to FP.

NURHI also formed Budget Task Teams to influence the budgeting processes and decisions by the State and LGAs.

In addition, NURHI entered into performance based sub-agreements with HERFON for advocacy among policy-makers, DEVCOMS for advocacy among radio, TV, and print journalists, and Advocacy Nigeria for advocacy among traditional and religious leaders. These organizations worked closely with the ACGs and the NURHI teams while also making tremendous institutional strengthening gains.

In 2010, NURHI facilitated an Advocacy Strategy Design Workshop to design four city-specific and one national advocacy strategies based on the formative research results and available 2008 National Demographic and Health Survey (NDHS) data.  NURHI advocacy staff and partners, FMOH, SMOH, and two ACG members from each of the four initial cities participated in this exercise, using the Smartchart 3.0 tool developed by Spitfire Strategies. Spitfire outlines a step-by-step process to define and prioritize advocacy issues and develop results and evidence-based advocacy strategies.  NURHI used the workshop as an opportunity to train participants in the Spitfire approach while designing city-specific and national strategies.

Following the workshop, NURHI combined the four city-specific advocacy strategies into one strategy document. The project shared this document with the ACGs from each city for review and revision.  These revised strategies were used to develop city- specific advocacy workplans.  Each year, the ACGs prepares an annual workplan, which they review and updated quarterly. 

NURHI records success stories highlighting achievement such as improved access to FP services, increased FP budget lines and expenditures for FP consumables as well as support to FP received from the religious and traditional leaders.

NURHI and its partners supported ACGs and the Family Planning Action Group (FPAG) to implement their advocacy strategies through a number of activities:

• Developing advocacy materials and tools
• Training to strengthen advocacy skills
• Conducting national and state-level policy dialogues: A major activity in site specific advocacy plans involves organization and/or participation in state, city, or LGA family planning advocacy and policy dialogues.  ACGs and NURHI have identified and engaged “Family Planning Champions”--influential citizens interested in actively supporting family planning—to speak during meetings and events.  ACGs and NURHI have organized public events with highly visible media coverage; and have participated in the National Family Planning Conference.
• Media advocacy
• Engaging religious leaders
• Community based advocacy
• Budget tracking
• Policy de-briefs

NURHI established a system to monitor implementation of Advocacy Strategies and make adjustments as required.   The system involves quarterly meetings and reviews by ACGs and Budget Task Teams, family planning budget and expenditure tracking, and reporting to NURHI.  If weaknesses or challenges are identified through this process, NURHI, ACGs and Budget Task Teams take corrective action.

Each year, as part of the NURHI workplan development process, project staff meet with the ACGs, government staff and other stakeholders in each city to review progress on site-specific advocacy strategies and decide what activities need to take place in the following year.  NURHI shares these recommendations with the ACGs, which prepare annual advocacy plans.   NURHI reviews and integrates city-specific plans into its annual workplan.

The MLE Mid-term Survey provided useful information concerning public attitudes and knowledge about family planning that NURHI advocacy efforts have contributed to. NURHI used this information to fine-tune its advocacy plans. The MLE Endline Survey will also provide information concerning attitudes and approval of family planning as a means of evaluating the contributions of NURHI advocacy efforts.

In the fourth year of the project (2012/2013), NURHI scaled up to two additional cities, Benin City and Zaria:

• In Benin City, NURHI replicated the innovative ACG approach to build consensus and achieve improved policy environment for FP. A site-specific ACG was formed and the group was trained in advocacy skills. A Site-specific advocacy kit was developed to support effective policy dialogues and advocacy.
• In Zaria, NURHI modified its approach, since Zaria shares similar sociocultural and demographic environment with Kaduna (both being in the same State).  The Kaduna ACG was enlarged to also cover advocacy needs in Zaria. The conservative nature of the population in Zaria also demanded that more attention be paid to sociocultural sensitivities particularly from the religious leaders. NURHI utilizes an interfaith forum as a platform for engaging Christian and Muslim religious leaders together to address issues in support of family planning and childbirth spacing.