Adapting to Covid-19: ExpandNet’s Discussion with Dr. Sada Danmusa of the DOS Center/Mid-Space in Nigeria
ExpandNet is collaborating with a project in Nigeria, the Technical Support Unit (TSU) project led by Dr. Sada Danmusa who leads an NGO called Development Outcomes and Support Center (DOS Center). A key focus of their ambitious project is to strengthen the family planning (FP) capacity of state government leaders to take ownership and more effectively implement the country’s family planning program. The project uses various mechanisms to strengthen these leaders’ capacity to use data to set priorities, manage implementation and adapt innovations and best practices for continuous improvement of FP outcomes. One of those mechanisms, the Transparency, Advocacy and Capacity building (TRAC) platform supports quarterly meetings to build the skills of state leaders from the various geo-political zones in Nigeria to use data for decision making and disparity analysis in family planning performance. These efforts combined with other interventions at the federal and state level, have generated new commitments to improve family planning and reproductive health outcomes.
In the current phase the project has worked in the Northwest and Southwest zones of Nigeria, each containing an average of 6 states. Over the next three years the plan is to scale up the TRAC platform to cover the remaining four geopolitical zones of Nigeria, and thereby all states in the country.
The Covid-19 epidemic in Nigeria, however, challenges Dr. Sada and his NGO to continue to progress. Below are his responses to five questions the ExpandNet Secretariat team asked him about how he expects to deal with the crisis:
ExpandNet team: Will you be able to continue the TRAC meetings during the Covid-19 epidemic in Nigeria?
Dr. Sada: Within the larger goal of ensuring government ownership, we see the Covid-19 situation as a further opportunity to challenge the government folks to demonstrate their leadership abilities and provide direction for their states. We started discussions at both national and state levels towards this new normal and have so far agreed on a comprehensive shift on how states will continue to lead these processes and other program activities. These include the following:
- Hold TRAC meetings remotely: The project will support state leaders to continue to lead TRAC meetings online during the lock-down period. We have discussed with the states that we might need to support them to hold these online meetings. Training is needed on how to interact online, how to host meetings, how do you move into group work, how do you move into plenary session. We have discussed this with our IT person and will be holding these trainings for the TRAC members as we move forward. If remote meetings work well, we will continue online meetings after the crisis is over. It will greatly reduce the cost and time for travel, which has been a big challenge for top leaders.
- Revamp pre-meeting preparations and planning: Since online meetings can only be held for a short period of time, (as against physical meetings), we will support states to make adequate preparations to hold short, targeted and effective meetings. In that vein, we have created WhatsApp groups to hold timely and iterative planning preparations, which would include sharing of documents, data and plans.
- Move to sharing and using electronic documents, rather than hardcopy documents which they are more used to.
As facilitators we will continue to provide technical assistance in data review and quality assessment and will provide key questions and guidance for disparity analysis and discussions.
ExpandNet team: How will you address the Covid-19 crisis in the TRAC meetings?
As our major focus is enhancing government capacity for leadership, most of the initiatives and mechanisms we employ are transferable across programs and issues. A key example is our focus on building capacity for evidence-based decision-making. Presently, leaders draw data specific to their states from the national health information system (NHIMS), review such data for quality and analyze it to bring out what it is saying about the program. This forms the basis for decision-making and planning.
The response to the Covid-19 epidemic clearly requires real-time data analysis and decision-making, the skills we seek to strengthen among the leaders. Going forward, we will add Local Government Area (LGA) analysis of Covid-19 data through the TRAC communication channels, thereby providing key understanding on how the virus and the response to it is evolving at these lower levels. We recognize of course that in comparison with family planning there remain many unknowns about Covid-19 that will have to be addressed as the crisis evolves. However, having this lower level data visibility is critical to quickly responding to the epidemic and addressing it within the overall health system context. Analysis of the FP program will not be disrupted since we would be adding the Covid-19 data into the analysis and discussions.
ExpandNet team: What other adaptations do you plan to make to cope with the Covid-19 crisis?
Dr. Sada: We looked at this within the ambit of building capacity of governments to continue their role of coordination and delivery of health services. Therefore, we are holding brainstorming sessions with government officials to develop context-specific plans to ensure continuation of service delivery. So far, we have:
- Started building capacity of government officials on information technology (IT) to be able to work remotely. We see them beginning to appreciate the need for an institutional shift towards electronic governance, which the government has already been discussing before this pandemic. It is important to note that this new normal will require a big paradigm shift of government institutions to embrace electronic governance along the whole chain from the national level to the level of LGAs. We will support as many of the state governments participating in the TRACs as possible to make this shift.
- Planned on supporting government to search for targeted solutions to ensure services reach communities within and beyond the lockdown periods. Our main focus is working with the states within the TRACs to strengthen devolution of tasks to lower level providers and other community channels by encouraging expanded implementation of the health provider task-shifting policy from higher to lower level cadres. This will be especially important now for family planning because higher level providers will be needed to combat Covid-19.
- In addition, we are implementing decisions reached by the national committee on SRH services in response to the Covid-19 situation which are focused on ensuring that SRH services continue. In order to implement some of these decisions, there is often need to facilitate states to speedily adopt certain national policies that may not existing in the states. For instance, there is a need for strong advocacy to get local authorities to allow proprietary patent medical vendors (PPMVs) to stock some contraceptives.
ExpandNet team: Contraceptive supply stockouts were already a major issue in Nigeria. How do you think Covid-19 will affect the FP medical supplies system? Will there be contraceptive medicines and supplies available to provide FP services.
Dr. Sada: The TSU is working through its participation on the national Procurement, Supply and Management Committee to ensure states are fully involved in decisions related to supplies from the national level. Overall, we envisage that this situation is an opportunity to facilitate progress in decentralizing procurement and distribution of commodities, which is currently centralized at the national level.
ExpandNet team: You are working within the principles of government ownership and capacity building which are so central to scaling up. Other key lessons about scale up that are centrally related to what you are doing, are 1) Keep the innovation simple; and 2) Avoid overly rapid pace of scaling up.
By seeking to address the Covid-19 pandemic in addition to family planning you are adding to the complexity of the TRAC innovation. Moreover, by seeking to scale up from the NW and SW zones of Nigeria to the entire country in the period of 3 years you are moving relatively fast.
Please discuss what appears to be a contrast between key scale-up lessons we have learned and your plans for expanding the innovation and reaching national scale with a relatively rapid pace.
Dr. Sada: We view this issue at two levels:
- Even though we focus on FP, the whole TRAC process is based upon the basic foundation for scale-up – capacity for evidence-based decision-making, adoption of best practices and innovations, direction and strategy setting etc. – rather than the detailed scale-up of individual interventions. Therefore, we anticipate that this is going to be a replicative scale up of a mechanism we already have good lessons learned from the initial two TRAC zonal platforms. We believe that we would do this in a shorter time and with fewer resources since we have already defined and itemized what is needed at the formative stages of the platforms, namely: mechanisms and extent of engagement, with whom that makes sense, what capacity is needed initially, etc.
- In terms of scale up of specific programs (i.e from FP alone to FP + Covid-19), we believe that even though this type of scale-up presents risks when done speedily, we already have an existing, expandable mechanism that could adapt to absorb as many programs as the leaders have responsibility for. Certainly Covid-19 is a new situation and there are a lot of ‘unknowns’. However, we also feel a crisis at such a scale as the Covid-19 will certainly change how the whole system operates, including the way the system scales-up interventions. Consequently, we view adding Covid-19 to the current TRAC process as an opportunity to further test and adapt the overall health system and its supportive structures.
 The interview was edited for space and clarity by both Dr. Sada and the ExpandNet Secretariat.