Subsidy Reinvestment and Empowerment Programme Maternal and Child Health Initiative Impact Evaluation (SURE-P MCH) 2013
The Maternal and Child Health (MCH) project of the Subsidy Reinvestment and Empowerment Programme (SURE-P), was set up by the Federal Government of Nigeria to reduce maternal and newborn morbidity and mortality inthe country. MCH initiative is a follow-up program to Midwives Service Scheme, implemented by the Nigeria National Primary Health Care Development Agency, that provides demand and supply side incentives, community monitoring, and increased human resources to improve the rates and quality of antenatal care and skilled birth attendance in Nigeria.
On the supply-side, SURE-P aims to recruit, train and deploy 5,400 midwives and 14,100 community health extension workers, as well as to upgrade essential infrastructures and guarantee the adequate provision of supplies and equipment to primary health centres between the end of 2012 and 2015. In addition SURE-P will hire and train a total of 38,700 village health workers, who are expected to establish the connection between the primary healthcare centres (PHC) and pregnant women in each village.
On the demand-side, SURE-P introduces a CCT, whereby all pregnant women will be given a total cash payout of 5,000 Naira (about USD 32), conditional on attending antenatal care, skilled birth attendance and postnatal care. Also, an information campaign aims to target all women of reproductive age to encourage them to register with their nearest PHC.
The rigorous impact evaluation is being implemented to determine the causal impact of this programme. The IE comprises a quasi-experimental impact evaluation whose aim is to evaluate the SURE-P package, and four experimental evaluations which will evaluate the impact that distinct components have within the SURE-P package, such as:
- the effect of alternative incentives regimes to midwives on their retention rates
- the effect of conditional cash transfers on utilization of MCH services
- the effect of community monitoring of essential commodities on incidence of stock-out of supplies at the PHC
The baseline data collection was carried out in September-November 2013. The first follow-up survey will be implemented in November 2014 - January 2015, after SURE-P Phase I implementation. The final data collection is planned one year later, from November 2015 to January 2016, after SURE-P Phase II implementation.
To gather baseline data four different groups of respondents were interviewed using different questionnaires. These respondents were:
- Managers in all 500 SURE-P health facilities across the country
- Midwives recruited by SURE-P
- Women who gave birth three months preceding the survey, in sampled households in each SURE-P facility catchment area
- Ward Development Committee (WDC) chairpersons or representatives in all SURE-P facilities.
Overall, 476 facility manager questionnaires, 1,291 midwife questionnaires, 2,378 household qustionnaires and 477 WDC questionnaires were administered.
The baseline data is documented here.
Kind of data
Sample survey data [ssd]
Unit of analysis
- primary health care facilities
- pregnant women
Producers and sponsors
Pedro Rosa Dias
University of Sussex
University College London
Public Health Advisor
SURE-P MCH IE Field Coordinator
DIME IE Coordinator
M Abul Azad
DIME IE Implementation Coordinator
Bill and Melinda Gates Foundation
Strategic Impact Evaluation Fund
Hanovia Medical Limited
Hanovia Medical Limited
Hanovia Medical Lmited
Lead Data Officer
- Primary Health Care facilities: The survey targeted all 500 SURE-P MCH Phase 1 PHC facilities.
- Midwives: The survey targeted all midwives currently working for the SURE-P MCH (up to four per Primary Health Care facility). The list of all SURE-P midwives with their identification numbers was provided to the survey firm. Some midwives, whose names were not on the list, were found and interviewed during the survey.
- Ward Development Committees: The survey targeted all 500 ward development committees operating in areas with SURE-P MCH Phase 1 Primary Health Care facilities.
- Households sampling
The interviewers first visited the SURE-P facilities and asked for the names of the communities within its catchment area. The names of communities were written in a piece of paper, crumpled and placed in a bag. The papers were randomly drawn and two communities selected.
All structures in communities with 50 or less structures were listed. Communities with 50 to 100 structures were split into Enumeration Areas (EAs) of approximately 25 structures, out of those two EAs were randomly selected and fully listed. Communities with more than 100 structures were also split into EAs and three EAs randomly selected.
The listing was conducted using the World Bank designed listing form. All listed households with eligible women were entered into a generated sampling form. Households with the smallest numbers in the "sampling order" where chosen for sample.
A sketch of the community maps was also obtained.
- Primary Health Care Facilities Questionnaire
Target: 500; interviewed: 476; response rate: 95%
The survey implementation team consists of core management, zonal coordinators, state supervisors and interviewers. The core management team includes the Project Manager (PM) supported by a field coordinator and a logistics manager. Six zonal coordinators, 37 state supervisors, 148 interviewers and 37 "listers" were recruited in all states.
Due to the adequate training and competence of most team members, data quality assurance was a primary responsibility of each interviewer. Each interviewer was required to take adequate time in answering each question and entering answers correctly into the tablet. Interviewers also took time to review each completed questionnaire before leaving the spot where the interview was conducted. The supervisors were available to observe some interviews conducted.
Supervisors randomly went through a couple of forms on different days to check the collected data before dispatching it to the server.
Feedback from the World Bank on quality of collected data was shared with the survey firm. Some interviewers went back to the field to collect additional information if there were some concerns.
Four questionnaires were used to collect data for SURE-P MCH IE baseline survey.
1) Primary Health Care Facilities Questionnaire includes the following sections: (i) general information; (ii) facility characteristics; (iii) administration and management; (iv) human resources; (v) organizational citizenship and behaviors; (vi) Maslach Burnout Inventory (MBI); (vii) patient records; (viii) community outreach; (ix) health services; (x) user fees; (xi) national protocols; (xii) equipment; (xiii) drug storage and availability;
2) Midwives Questionnaire includes the following sections: (i) general information; (ii) post-secondary education; (iii) exposure to rural settings; (iv) job attributes preferences; (v) Maslach Burnout Inventory (MBI); (vi) work conditions; (vii) family; (viii) altruism game; (ix) other sources of income; (x) household assets, land, and animals; (xi) non-experimental measure of intrinsic motivation; (xii) time preferences game; (xiii) community relations and support; (xiv) prosocial scales; (xv) midwifery courses preferences; (xvi) antenatal care (ANC); (xvii) opinions about work and family; (xviii) contact information; (ixi) risk preferences game; (xix) post-contract expectations*; (xix) social norms game.
The study tests the effectiveness of three different incentives regimes for midwives (monetary only, non-monetary only and monetary plus non-monetary) versus a control group. The midwives baseline survey was used to deliver the relevant contract to each midwife, with midwives in the control group receiving a generic letter. The post-contract expectations section of the midwives questionnaire asked a basic set of questions on midwives' expectations related to various aspects of their work immediately following receipt of their contract letter.
3) Households Questionnaire includes the following sections: (i) contact information; (ii) household roster; (iii) education; (iv) transfers and other income; (v) adverse events; (vi) household health services utilization and payment; (vii) community organizations; (viii) male adult expectations; (ix) reproductive health; (x) antenatal care service utilization; (xi) labor and delivery; (xii) Edinburg Postnatal Depression Scale; (xiii) postpartum care and breastfeeding; (xiv) female adult expectations; (xv) maternal knowledge; (xvi) delivery problems; (xvii) exposure to media and mobile phones; (xviii) village leader and ward development committee interaction; (xix) dwelling characteristics and household amenities; (xx) household assets; (xxi) food and non-food consumption.
4) Ward Development Committees Questionnaire includes the following sections: (i) general information; (ii) access to basic services and community characteristics; (iii) social capital and community empowerment; (iv) external shocks; (v) direct observation.
Hanovia Medical Limited
Data cleaning was carried out in phases at the end of the field exercise. Data cleaning commenced with the correction of wrongly captured midwives identification (ID) numbers in the midwives and post-contract surveys. Corrected midwives IDs were further matched using STATA to identify missing midwives IDs. At the end of this exercise, a number of missing IDs were discovered and addressed by conducting fresh interviews. Plateau and Taraba states recorded the highest cases of midwives with missing post-contract survey forms.
Household data was cleaned by identifying duplicate IDs within the facilities and by correcting household IDs which were not correctly recorded. The household listing and sampling order forms served as reference books for confirmation of the IDs where concerns were raised. Facility and WDC files were cleaned by identifying duplicated facility IDs within the states. Identified IDs were cleaned by calling the person in charge of the facilities and WDC chairs to clarify which facilities they fall under.
The use of the datasets must be acknowledged using a citation which would include:
- the identification of the Primary Investigator (including country name);
- the full title of the survey and its acronym (when available), and the year(s) of implementation;
- the survey reference number;
- the source and date of download (for datasets disseminated online).
Pedro Rosa Dias, University of Sussex; Marcos Vera-Hernandez, University College London; Marcus Holmlund, World Bank. Nigeria Subsidy Reinvestment and Empowerment Programme Maternal and Child Health (SURE-P MCH) Impact Evaluation 2013, Baseline Survey. Ref. NGA_2013_SUREPIE-BL_v01_M_v01_A_PUF. Dataset downloaded from [URL] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.