Impact in Action

Essential Health Service (EHS) Delivery During COVID-19: Global Financing Facility (GFF) Workshops Seek to Assess and Improve Continuity of EHS Provision in Nigeria

Identifying high-performing Local Government Areas that reduced essential health service delivery disruptions during the pandemic may lead to concrete and replicable examples about what contributes to resilient health systems.

What is the problem to be solved?

The COVID-19 pandemic has strained health systems and created significant disruptions to essential health services (EHS), including reproductive, maternal, newborn, and child health services, around the world. If not accurately or consistently monitored, health systems may not be sufficiently equipped to adapt to disruptions when they do occur.

The Global Financing Facility for Women, Children, and Adolescents (GFF) supported low- and middle-income countries (LMICs) to monitor EHS service disruptions so that new data could be used to improve real-time response, improve service delivery, and inform policy decisions. It is also providing EHS grants to LMICs.

In Nigeria, the GFF collaborated with the Federal Ministry of Health (FMOH) to quantify disruptions to essential health services using routine health management information system data on service volumes. The GFF also supported the FMOH to conduct nine rounds of facility-based phone surveys as part of their broader goals to support countries in maintaining essential health service delivery, providing additional context on reasons for disruptions, adaptations, and gaps in facility-level resilience to COVID-19.

What steps are being taken?

The GFF is working with Ministries of Health to facilitate workshops to review and validate national and state-wide estimates of EHS service disruption through the pandemic, identify and prioritize barriers and facilitators to ensure equitable continuity of EHS, and propose action plans to strengthen health service delivery.

The first of such workshops occurred in March 2022 in Abuja, Nigeria, where the country’s Federal Ministry of Health hosted federal and state health officials. During the workshop, participants from twelve states gave feedback on data showing EHS results in their state, and shared perspectives on how monitoring exercises can inform decision making. This collaborative approach to data review and use included identifying learnings from high-performing Local Government Areas (LGAs), promoting state-state learning.

The GFF had already been running the subnational Local Government Area-level quantitative research and as part of this work, asked Exemplars in Global Health to provide qualitative research support alongside our research partners at the University of Ibadan and Makerere University. Our coalition of Exemplars in COVID-19 Response research partners documented best practices from countries that effectively responded to the COVID-19 pandemic while ensuring continuity of essential health services delivery, and our work in Nigeria focused on testing and surveillance strategy and essential health services maintenance.

How is Exemplars in Global Health supporting this work?

At the workshop, EGH’s in-country research partners at the University of Ibadan served as facilitators for state-level discussions. They also presented findings from EGH’s essential health services research sprint in Nigeria (part of our Exemplars in COVID-19 Response work) with the goal of stimulating ideas for states’ action planning around essential health service maintenance.

Now, EGH is partnering with the GFF to conduct the subnational positive deviance analysis that will identify and describe experiences of high-performing LGAs that were able to maintain essential health services during COVID-19. While the GFF team will lead the quantitative research for this study, EGH partners at the University of Ibadan will oversee and guide the qualitative research. The qualitative research will mostly consist of key informant interviews with primary care facility managers, LGA health officials, and state health leaders conducted by Hanovia Limited, a qualitative research firm based in Nigeria. The findings will allow state governments to compare positive outlier LGAs and comparator or standard case LGAs, to explore how two LGAs with different levels of performance within the same state differed in their approaches.

What next steps did workshop participants agree to take?

After the Nigeria data-use workshop, participants created action plans to address their unique challenges and mapped out resources required for their proposed solutions.

A participant WhatsApp group was created to support a community of practice and a broader culture of data use in decision making. Discussions about updated state and national results will be shared among group members, who continue to engage beyond the workshop.



The combined workshop and positive deviance analysis approach will help engage local health system actors and support a larger agenda of data-informed decision making.

The workshop itself provided attendees with an opportunity for sharing experiences and learnings across states. Attendees also learned from the national experiences that made Nigeria a top performer in COVID-19 response. By identifying the characteristics and actions of high-performing LGAs, EGH-supported research is expanding the knowledge base about what contributes to resilient health systems in Nigeria at the local level, where services are delivered. According to a survey of workshop participants across all twelve states, 91 percent reported that the results of the FMOH and GFF-supported analysis of essential EHS disruption matched their experiences on the ground, and 93 percent reported that the results were useful for decision-making.

Following the workshop, EGH is committed to two priority goals in Nigeria:

  • Collaborate with in-country partners to understand and influence country-specific policy updates, such as state guidelines on maintenance of EHS, broader pandemic response guidelines, and health systems strengthening plans (National Action Plan for Health Security) through uptake of our research findings at the subnational level
  • Encourage state-state learning through implementation of lessons learned in positive outlier LGAs, and identify and share best practices for processes implemented through engagement with state- and national-level stakeholders

Additionally, the GFF is interested in collaborating on similar workshops in other interested countries, so best practices can be identified and shared within their individual contexts, with an aim of building a broader understanding of resilient health systems across countries.

Interested in learning more about COVID-19 Response?

Explore our platform to learn more about COVID-19 response, understand cross-cutting lessons and early insights on epidemic preparedness from Exemplar countries’ early insights and epidemic preparedness, or read perspectives on COVID-19 preparedness and response from our partners.

Reach out to the Exemplars in Global Health team to learn more about the work described in this article or to discuss how we can support your work.

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