Evidence-based Health Programme Planning in Northern Nigeria: Results from the Nahuche Health and Demographic Surveillance System Pilot Census

Introduction: In 2009, the Partnership for Reviving Routine Immunisation in Northern Nigeria (PRRINN) Maternal, Newborn and Child Health (MNCH) Programme, in collaboration with the Zamfara State Ministry of Health, launched the Nahuche Health and Demographic Surveillance System (HDSS) in a rural north Nigerian setting. Located in Bungudu Local Government Area in Zamfara State, the Nahuche HDSS will support studies aimed at assessing the impact of health systems interventions by monitoring health as well as demographic events and populations at risk over time. This paper reviews the Nahuche model of surveillance as well as selected demographic, maternal and health indicators and their potential in guiding programme planning particularly in resource-constrained northern Nigeria. Potential interventions to address these challenges are also discussed. Methods: In May 2010, a pilot census (194 households interviewed out of targeted 205 households) was conducted in Nahuche Keku District followed by a full baseline census in September 2010 and periodic event updates of 120day work cycles which begun in January 2011. Results: Poor maternal and child health indicators were observed. For example, 19.8% of all women (n=131) with live births in the five years preceding the pilot census had received antenatal care from a health professional for their last birth. Only 9.2% reported that their births were delivered by a health professional. An even lower proportion (6.6%) delivered in a health facility with 93.4% of all births occurring at home. Conclusion: Despite the fundamental problems associated with strengthening health systems in northern Nigeria, the Nahuche HDSS will generate opportunities for testing feasible interventions and set the stage for reducing the high maternal and child mortality rates. The Nahuche HDSS is a system to watch based on its location and the enthusiasm of Nigerians to accelerate progress in meeting the Millennium Development Goals of maternal and child mortality.