Case Study of Nigeria’s experience scaling up chlorhexidine use in newborns, 2016-2021: analysis of implementation of actions to support scale-up and progress towards institutionalization
Bibliographic record
Abstract
ABSTRACT Background Application of chlorhexidine (CHX) to the umbilical stump is an evidence-based intervention to prevent newborn infections. Successful pilot experiences led the Nigeria Federal Ministry of Health (FMoH) to launch a national, five-year scale-up strategy in 2016. In this case study, we analyze the implementation of national and state-level scale-up actions described and mandated in the national strategy and progress toward institutionalizing CHX within the routine health system using the WHO building blocks framework. Methods We conducted a mixed methods case study that consisted of interviews with key informants after the midline of the national strategy; focus groups of well-informed senior stakeholders at midline and endline of the strategy to assess the level of institutionalization achieved and the status of implementation of national-level scale-up actions described in the national strategy; and online surveys of state reproductive health coordinators (SRHCs) at midline and endline about implementation of state-level actions and the extent of international partner support. Results Institutionalization of CHX progressed steadily across all health system building blocks. Most rapid progress was in governance, followed by human resources and supply chain management, with slower progress on the health information system. The building block lagging most was financing, with continued dependence on external funding. Most but not all national-level actions were implemented as planned. There was wide variation in the implementation of state-level actions included in the national plan. Discussion and Conclusion Nigeria has made substantial progress in institutionalizing CHX across the health system building blocks. In terms of implementation of planned state-level scale-up actions, wide variation points to the need for more sustained and coordinated action, and the importance of actively managing this coordination. At national level, as Nigeria continues in the second phase of its scale-up efforts, the FMoH needs to strengthen coordination and financing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".