Good report – BUT how do we move from reports to impact


Every year our Federal Ministry of Health, and the multitude of development partners at its service produce hundreds of reports about their plans and activity. Most of these reports are hidden away on dusty shelves, deep inside websites that no one goes to. Many of the reports are poor and will not stand the scrutiny of enlightened peer review. Some are sprinkled with pictures of newly repainted primary health care centres as evidence of improved health care services. Once in a while a good report is produced that actually addresses some of the major challenges of our time.

It is no longer a secret that Nigeria is at significant risk of not meeting the the Millennium Development Goals 4 and 5.

MDG 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. 

MDG 5: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Did you know that every day in Nigeria, about 700 babies die (around 30 every hour). This is the highest number of newborn deaths in Africa, and the second highest in the world. 

A new report – Newborn Health represents a major milestone to plan for Nigeria’s 241,000 newborns who die from preventable and treatable causes every year. Published under the  auspices of the Federal Ministry of Health, and developed by Save the Children in collaboration with major stakeholders, the stated goal of the report is  to accelerate action by dutybearers to save the lives of Nigeria’s newborns.

One obvious innovation in this particular report, are written commitments from the development partners, our Federal Ministry of Health, professional bodies and even representatives of the people.

Filled with well analysed and presented data on the Nigerian health sector as it relates to maternal and child care, the report is an excellent summary of where we are and how we can make progress. It ends with a call for action around 5 well articulated recommendations. For me personally, the most striking fact in the opening sections of the report was that “key interventions to save newborn lives are mostly possible through the existing health system and will prevent the deaths of mothers and older children …but coverage remains poor” ….Below is some of the data. Data that should absolutely shock our leaders and drive them to action. But unfortunately neither our leaders, most of health professionals or the public at large have quite come to terms with the enormity of challenges that face us in the health sector.

  • Exclusive breastfeeding of infants less than six months – 13%
  • Had at least 1 Antenatal visit in pregnancy – 58%
  • Has received 1 Measles vaccination –  41%
  • 12 states where less than 20% of women give birth with a skilled attendant present
  • Coverage is especially low for modern contraception use (10%) 
But this really is not what this blog is all about. We found this report in an obscure newsletter that summarises new publications of relevance in global health. I spent the last few days contacting my colleagues across the country, paediatricians, gynaecologists, nurses…not a single one of them had heard or even seen this report. I have sent it round to all of them…but just to the small group in my network. 
With the money spent on this report, why was there so little obvious effort in launching it, in making it public, in sharing it with people that need to know. Where was the related advocacy campaign around the report? Where was the effort to inform mothers on the findings so that they would hold our leaders to account. Who is measuring the impact of this report? Impact…impact? What was the impact? What is the impact? 
While we are pleased with the emergence of this important document, we ask that all the major partners in our health sector think about the ethical imperatives of spending significant resources on reports, and the opportunity cost of not spending them on health interventions. If we have to write these reports, then we have to plan and fund a communications plan around it. We see from the website of our Federal Ministry of Health that there are plans for a “Data Inventory and Documentation Initiative (DIDI)” This might solve the problem, but we have learnt the hard way in our country not to believe the big long acronyms, and wait to see the final product.  
One approach to solving this would be an undertaking by our Federal Ministry of Health, and our development partners to publish the detailed costs of any report published. Only by knowing what the report has cost to produce can we estimate how may children lives might have been saved not by the inactivity of those that can act, but their activities in the wrong endeavours. 
Having said that – this is a very good report – especially the state specific summaries at the end. 
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Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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