Abstract
In 2009, the Targeted States High Impact Project (TSHIP), the USAID/Nigerias flagship project, started improving the quality and delivery of a number of integrated high impact maternal, newborn and child health (MNCH), family planning (FP), and reproductive health (RH) interventions in two States, Bauchi and Sokoto in Nigeria. The TSHIP, along with other USG projects, is part of USAID/Nigerias focus state strategy designed to achieve impact at the state level. The TSHIP design was based of the achievements of prior USG projects, and on a number of assumptions, to achieve the following four strategic subobjectives as measured by 25 indicators: (1) strengthen State and local capacity to deliver and promote high-impact interventions; (2) strengthen service delivery at primary health centers (PHC) and referral levels; (3) strengthen the roles of households and communities; and (4) improve policies, programming and resource allocation. Some of the evaluation findings include: (1) TSHIP has effectively introduced a number of high impact MNCH/FP/RH interventions, trained large numbers of health providers in both States and advocated for a number of system strengthening activities; (2) TSHIP has achieved high levels of visibility and good will among all beneficiaries, raised the level of awareness about quality of care, coverage and community engagement, and created and strengthened an effective community platform, the Ward Development Committees (WDC), to expand the community-based delivery of the target interventions; (3) project progress indicators show that in spite of these achievements, the project has not progressed as planned due to various factors; (4) the state-wide focus and the five TSHIP strategies used to guide project implementation so far have helped the project face the challenges of improving health services at the same scale as the focus states; (5) TSHIP's five overarching strategies do not seem to have followed the approach described in the grant application and the TSHIP Team has not yet taken "the next step" to ensure the stakeholders use interventions and incorporate them in their routines; (6) project activities seem to have had much breadth, but not enough depth to effect and sustain change; (7) integrating MNCH/FP health services was the main goal of the TSHIP, but it is not evident; (8) the critical assumption that the essential medicines and supplies would be there for the target interventions to be implemented was not valid; (9) TSHIP's achievements are appreciated by state, LGA and WDC authorities, but are not owned by them; and (10) the grants component has been delayed and is two years behind. (Excerpt, modified)