Despite the huge investment in the health sector in the last 2 decades, Nigeria did not achieve the MDGs. At all levels, the Government is working with all stakeholders to implement interventions that will address system bottlenecks and rapidly produce results for women and children. Nigeria will need to increase by 9-fold the current rate of programming to change the trajectory for health indicators towards the achievement of the SDGs. Using data analytics through the AAI approach has galvanized effort and resources to be invested in communities with the greatest need solving problems that have the greatest impact on the health of women and children

The objective of the AAI approach is to support the Government and other partners leverage data through a multisectoral participatory process to accelerate action towards the rapidly achieving results for women and children

 Regular coordination meetings and joint actions among Implementing partners (State MDAs – SPHCDA, MOH, MEBP, MoAgric, MoEd, RUWASSA; EU, GAVI, UNICEF, WHO, USAID and INGOs)
 Traditional, religious and community leaders engaged in review and analysis of results & challenges
 Innovative partnership with Jumu’at Mosque committees and establishment of Mama-to-Mama groups for demand creation and health promotion

AAI strategy acts by selecting the communities with the highest morbidity/mortality, targeting the challenges with high impact interventions and tracking progress for adaptive programming. Each ward, district and health facility was supported to develop and implement quarterly workplans, the implementation of which were monitored closely by stakeholders including at the highest level by the steering committee chaired by the Executive Governor of the state.
Some of the key interventions the state and the districts were supported to implement include
 Redistribution and engagement of healthcare workers in 4 priority LGAs in Kebbi State
 Outreach teams to HTR settlements/communities
 Mama to Mama community groups established and functional
 Strengthening community structures
 Demand creation through mosque committees
 Renovation/Upgrade of designated health facility to ensure one functional PHC per ward/settlement
 Commodity and equipment supply to facilities
 Capacity development of health care workers
 Strengthening multisectoral collaboration for accelerated MNCHN impact
Every quarter, stakeholders meet to Review and Revise priority interventions; Track Progress and Adjust as necessary. During each cycle, results are tracked through Multisector Child Survival Scorecards – see attached sample below.
Throughout the cycle, data quality improvement is ensured through uninterrupted provision of data collection tools, data quality assessment, data-related performance-based incentives, routine data validation and verification exercise

a) 87% of PHCs in four priority LGAs supported to have at least 2 midwives, from a baseline of 20%
b) Health facility coverage (health facilities reporting deliveries) in Kebbi increased on the Child Survival scorecard from 23% to 35% over 2018 and Institutional Deliveries improved to 37% from 12%, Deliveries by SBA improved to 42% by third quarter of implementation, from a baseline of 17%
c) The proportion of women attending ANC for the 1st visit improved to 96% from 46%
d) Data completeness and quality have also substantially improved over the year.

The above chart shows improvement in uptake of ANC services in the four selected LGAs implementing the AAI approach. The rates show LGA-specific performance of ANC 1 visit attendance over their quarterly targets (expected pregnancies/4).

e) Increased stakeholder participation and buy-in at the highest level bringing to fore the child health issues and priorities
f) The data driven approach of AAI has been integrated into national plans as a strategy to fast track progress working closely with the Federal Ministry of Health and National Primary Health Care Development Agency (NPHCDA)
g) Adoption and implementation of the data analytics approach in a contextualized manner in additional four States.
h) Development partners are rallying around the AAI approach and collaboration among partners is promoting synergies in support of State led plans and priorities.

Enabling conditions include strong commitment by Government leadership, ownership by traditional institutions and multisectoral participation.
Constraints faced included lack of policy implementation that will bring together the different agencies responsible for management of ‘primary health care under one roof’. This situation has limited the capacity of the state to undertake the redistribution, reward & punishment of health care workers responsible for the provision of basic primary health at the community level. Lack of release of counterpart funding, inability of the SPHCDA to access budgetary allocations and huge infrastructural gaps limiting the readiness of some PHCs to receive skilled staff.

The implementation of the AAI approach is hinged on using already existing platforms at all levels for acceptability and sustainability. Through the already existing ward development and health facility committees at the ward/settlement level, Mama2Mama support groups and the core technical committees (CTC) at the state level, health, nutrition, WASH and other social sector issues and challenges are being discussed and addressed
The commitment of the Emir of Argungu to improving health outcomes of the populace was instrumental in gaining the trust of the people and strengthening the linkage between the communities and the health system. The Emir chairs the Child Survival Task Force and have actively brought innovations for accelerating results for health, as well as provided guidance in adopting learnings from Polio eradication best practices including the adoption of Jumu’at mosque committees for health promotion and demand creation.
The AAI approach is linked to and reinforces the strategic, annual operational and action plans that already exist at different levels. The monitoring of the performance of these plans using the scorecards at various levels helps to build capacity of stakeholders in the use of data for planning, monitoring and evaluation of priority health interventions
Collaboration with other sectors such as the ministry of Agriculture and other projects being implemented with funding from the European Union, USAID, Global Fund and GAVI ensure that the approach is accepted and used across all programmes
AAI approach is already being Replicated approach across the remaining 17 LGAs of Kebbi State taking into account the learnings from the initial 4 LGAs. The approach is also being scaled up to other states across the country with 4 states currently implementing this strategy in selected LGAs and districts

AAI is maximizing existing opportunities and using data strategically to improve planning and delivery of high impact interventions for results
The strategic use of data has facilitated the engagement of policy makers, traditional and religious in accelerating action to achieve results in areas with high burden of maternal, newborn and child deaths
Leveraging data effectively across different sectors ensures acceptability towards action.
Community involvement especially the influence of the traditional and religious institution like the Emirs is critical to breaking community barriers and bottleneck
UNICEF will continue to support the Nigerian Government in building capacity for the implementation of the AAI approach across states for improved health outcomes