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Countdown Nigeria: A model for conducting implementation research

Sightsavers, April 2017

A group of seven men and two women standing/sitting in front of Countdown banners.

This post was written collaboratively by members of COUNTDOWN: Dr Obiageli Nebe, Phillip Okefu Okoko, Ruth Dixon and Laura Dean.

COUNTDOWN is a research consortium dedicated to investigating the cost-effective scale-up of sustainable solutions necessary to control and eliminate the seven most common neglected tropical diseases by 2020. In Nigeria, the COUNTDOWN project is a collaboration between the Federal Ministry of Health (FMOH), the Kaduna and Ogun State Ministries of Health, Liverpool School of Tropical Medicine (LSTM) and Sightsavers. COUNTDOWN is supporting implementation research, the outcome of which will provide the evidence needed for policy and programme change to enhance coordination and programme delivery. Activities began in Nigeria in September 2016.

To maintain the COUNTDOWN ethos of multidisciplinary equitable collaboration, we have built a partnership in Nigeria that focuses on the following areas:

Early involvement of key stakeholders in a genuine and trusting partnership

It is important to secure the full commitment of the Federal and State Ministries of Health to the vision and goals of the project and buy-in into the outcomes, increasing likelihood of taking up key findings that may inform policy.

Advocacy meetings with the FMOH, Sightsavers Nigeria Office and LSTM were held before any project activity. All partners were involved in the development of timelines, planning and project conceptualisation and all were on the panel during team recruitment.

The programme was launched on 15 March 2017 and received unanimous endorsement by the NTD Steering Committee, resulting in the COUNTDOWN Nigeria team being formally invited to the join the research sub-committee.

Having a multi-disciplinary and cross-sectoral team

Issues are not one dimensional; they are influenced by social, political, health, economic, operational and cultural factors. A multidisciplinary, multi-sectoral team allows a holistic approach and adaptability to country’s needs.

The COUNTDOWN team is led by the Federal Ministry of Health and includes social scientists, health economists, a research uptake officer (embedded in FMOH), and a research manager/officer. The collaboration includes LSTM bringing technical guidance and Sightsavers the perspective of large scale implementing partner.

Identify research needs that will address implementation issues in the local context

Implementation research is not a ‘one-size fits all’ solution; countries and contexts are different with varying challenges to NTD control and elimination programmes. Research that addresses a genuine need is more useful and more likely to be taken up, resulting in positive programmatic impact.

The preliminary phase of COUNTDOWN Nigeria has been a thorough and robust qualitative situation analysis of the NTD programme. It involves perspectives of Federal, State, Local Government Area (LGA), Primary Health Care and Community Directed Distributors/teachers involved in NTD programme delivery. Two States of Nigeria – Kaduna and Ogun – have been purposively selected as the focus of COUNTDOWN Nigeria and the situation analysis as they represent two very different NTD implementing environments. Key informant interviews (38) and participatory action research workshops (18) have been completed in three LGAs of each State. Data is currently being analysed to provide a full contextual understanding of each study area and inform research question development for the main study. Full scale research will begin in late 2017.

Maintaining effective and collaborative partnership

Research questions and implementation environments evolve. Only when partnerships are truly collaborative, can teams adapt together keeping research focussed and relevant.

The Nigeria COUNTDOWN team is led by the Federal Ministry of Health who have, and continue to take an extremely active and engaged role in planning, decision making and data collection. Open dialogues and honest communication have facilitated an evolving relationship between all three partners and successful resolution of any issues. At the recent partners meeting in Yaoundé (March 2017) all partners were present, including four participants from FMOH. Dissemination meetings for the situation analysis are planned for mid-June 2017, scheduled to allow feedback from each State to be inputted before the Federal dissemination workshop. Dissemination of the situation analysis will be followed by an evidence synthesis workshop and research planning meeting where questions will be formulated and planned, and which all partners will attend.

Linking to the global agenda

It is important to “be informed as well as informing”. By working in tandem with the global agenda and being current on wider sectoral issues, contributions to the evidence base can be more valuable to more people and non-duplicative.

The team is working in the context of the “leave no one behind” global agenda and the Nigerian national slogan “End the neglect of NTDs”. COUNTDOWN is a multi-country project where all country teams regularly get together for cross-country learning events. COUNTDOWN Nigeria has incorporated into the situation analysis a pilot of the new World Health Organization (WHO) Gender, Equity and Rights Tool with results presented at the WHO Strategic and Technical Advisory Group meeting in Geneva (17 Feb 2017). Results have also been included as part of a submission for an Equity Symposium at the American Society of Tropical Medicine and Hygiene. Early findings of the situation analysis have already been discussed at international forums such as Towards Elimination of Schistosomiasis (TES) conference in Cameroon (March 2017).

Conducting multidisciplinary implementation research can be complex, but is essential for cost-effective scale-up of NTD control and elimination interventions. We hope by using the guiding principles identified here that we can learn lessons to be taken forward to address some of the key bottlenecks currently faced by the NTD programme in Nigeria. Through the generation of our strong multidisciplinary team, we also hope to make recommendations for the success of cross-discipline and cross-country effective and equitable research partnerships.

Read about COUNTDOWN Nigeria’s recent launch

The COUNTDOWN team will be attending the NTD Summit organised by the World Health Organization, held at its headquarters in Geneva, Switzerland from 19-22 April 2017.

More information about Nigeria’s Department of Health

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