Setting up Village Health Committees in Nigeria help to improve quality of care

The Maternal, Newborn and Child Health Programme (MNCH2) is working in six states in Northern Nigeria through a health systems strengthening approach. One way in which it is doing this is by setting up Village Health Committees (VHCs) to work with the community to improve the quality of health care services.

A VHC is a community accountability mechanism which brings together staff from a government healthcare facility and members of the community who use the facility. VHCs meet regularly to allow beneficiaries and staff to discuss issues around services and to come up with solutions for how to address them. This social accountability mechanism allows community participation in decisions affecting healthcare in their community.

Overcoming poor quality of services is one of the issues that VHCs are changing through MNCH2. Poor quality services are known to be a barrier that prevents women from accessing reproductive and maternal health care. For example, if a woman has a negative experience with staff during an antenatal care visit, or a facility is dirty or does not have running water, then she is less likely to want to deliver in that facility.

Fatima Musa, an 18 year-old mother from Katsina state, recently gave birth to her first child. She is happy with the role VHCs are playing in strengthening facility and community relationships, that leads to improvement of health workers reception, management of drugs and facility cleanliness.

“The VHC ensures all husbands give permission for their wives to visit a facility once she is pregnant or when giving birth. I gave birth in this facility, the drugs were given to me for free. It was very effective and treated ailments very fast. I noticed the quality of the drugs is very good. I was so happy how the facility staff welcomed, accepted, treated and cared for me from the beginning of my labour to the end. I brought my child to the facility as there are quality and effective drugs.”

Fatima further explained that the VHC and the health facility are now the subject of discussions in the community thanks to the free quality and effective drugs. The commitment of the VHCs in supporting the facility with its requirements enables it to be successful. More people are now using the facility since the service has improved.

An evaluation recently took place in three of the six states to determine whether VHCs have contributed to improved quality of care. The research team conducted nearly 1,000 interviews and 18 focus group discussions with VHC members, healthcare staff and women who used facilities.

The evaluation found that:

• The majority of VHCs meet monthly with both community members and healthcare staff
• Facility healthcare staff are receptive to recommendations from the VHCs
• VHC members viewed ‘community mobilisation’ and ‘demand creation’ as the most important roles for the community

Almost all of survey respondents thought the establishment of a Village Health Committee influences the quality of healthcare services in health facilities.

The findings show that the systems developed by MNCH2 are having a positive affect within the community. It demonstrates that this platform brings together a diverse range of stakeholders to discuss concerns around service provision, with no financial incentives, which is in itself a success.

VHCs have achieved a number of tangible improvements in facilities, including:

• Raising or collecting money from the community to pay for drugs, staff wages, utility bills, develop infrastructure and ensure a 24 hour service operation
• Advocating for, or using their own means to provide emergency referral transport
• Mobilising fuel, and money for fuel, for electricity within the facility

Kaduna, 28, says; “The community is contributing a lot to improve the services of our hospital.  They help in building a ward, paying other utility bills like NEPA, and water.”

Ultimately, the VHC model appears to be very effective in Northern Nigeria, although not without its’ limitations. The facility is improving the quality of care in maternal and child health services, creating awareness and motivating community members to improve the use of services at health facilities. It has been recommended that the model should now be scaled up to include more facilities and additional states, in order to have a bigger impact.

MNCH2 is funded by UKAid from the UK government. Options is working as part of the programme team (led by Palladium) to improve essential health care for pregnant women, newborns and children in six northern states: Katsina, Kaduna, Kano, Yobe, Jigawa and Zamfara.

We are supporting the use of data on use of services to ensure that planning and decision-making by facilities and government staff respond to actual need. We are helping communities and civil society groups to access information on health services, and to use this information to demand better services when and where they are needed. Across the programme we are providing technical expertise to ensure that MNCH2 improves the quality of services – through training, lobbying for additional resources, better planning and resource management, and ensuring that staff and equipment are available at facility level. Find out more about the programme here.