Nigeria’s health system faces critical challenges, particularly in Human Resources for Health (HRH), leading to high rates of infant and maternal mortality and undermining healthcare delivery at the primary level. Despite various policy and programmatic interventions, gaps such as inadequate and inequitable distribution of skilled healthcare workers persist. To support Nigeria in addressing these challenges, the Bill & Melinda Gates Foundation (BMGF) engaged Sydani from Dec 2023 to July 2024 to develop a Learning Agenda focused on HRH, Skilled Birth Attendants (SBA), and midwifery solutions, especially in Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH+N).
Action (Strategy Design & Implementation, and Research):
Sydani developed a comprehensive Learning Agenda that included stakeholder engagement, data collection, analysis, and reporting across various HRH domains. Key Informant Interviews (KIIs) were conducted with stakeholders to gather insights into Nigeria’s HRH landscape. This process identified key issues, such as the inadequate availability of critical healthcare workers and their inequitable distribution across primary healthcare facilities.
Using the findings from these engagements, the team synthesized existing information and developed a solutioning model, called the EMBRACE (Ensuring, Motivated, Balanced, Resourceful Access to Skilled Birth Attendants) model, designed to guide investments and strategies aimed at improving HRH, SBA, and midwifery services.
The project also involved conducting case studies in selected states – Kano, Kaduna and Lagos – to validate the model and gather further evidence to inform national and sub-national policies.
To gather actionable insights, the research employed a combination of a scoping review, key informant interviews (KIIs), and a national polling survey of SBAs. Key actions included:
• Scoping Review: 109 resources from 16 countries were analyzed, focusing on HRH policies, models, and interventions. The synthesis identified opportunities for adopting global best practices.
• Key Informant Interviews: 53 interviews were conducted, including 43 at the state level across six selected states and 10 at the national level, to understand challenges in HRH distribution, retention, and performance management.
• National Voice Survey: A polling survey of 752 SBAs across 36 states and the FCT revealed critical gaps in HRH availability and disparities in salary expectations. Findings showed an average 71% HRH gap at PHC facilities, with a significant workload burden reported by 74% of SBAs due to workforce shortages.
Result:
The research highlighted a substantial HRH gap, particularly in PHCs, with a shortage of SBAs well below the Service Package standards. Notably, salary expectations differed by region and cadre, with nurses and CHEWs experiencing the largest discrepancies. The insights informed recommendations on salary adjustments and workload redistribution to enhance retention and improve HRH management across Nigeria’s PHCs. These findings set the foundation for developing tailored HRH interventions, including the EMBRACE model.
The project led to the development of actionable evidence-based insights to guide HRH decision-making and investment strategies in Nigeria. The EMBRACE model serves as a strategic framework for addressing the gaps in HRH, particularly at the primary healthcare level, focusing on increasing the availability, motivation, quality, and accessibility of SBAs.
Additionally, policy recommendations were formulated to support government efforts in strengthening the HRH/SBA landscape across Nigeria.
These accomplishments contribute to the broader goal of improving healthcare delivery and outcomes in Nigeria, particularly in reducing maternal and infant mortality through targeted HRH interventions.
