The Lafiyayyan Yara (Healthy Child): Reducing Infectious Disease among Children under Five (RIDCU-5) project was a 27-month private donor funded project implemented from October 2021 through December 2023. The project strengthened health systems in Bade Local Government Area (LGA) of Yobe state by providing required equipment and medication for health facilities, increasing capacity of health personnel to use approved diagnostic methods, and engaging the community to improve uptake of health services.
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
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The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases.