Example - Establishing an HDSS field site

CLIENT	Save the Children (UK) Nigeria Programme on behalf of PRRINNMNCH

PROJECT TITLE	Establishing an HDSS Field site in Zamfara state, Northern Nigeria.

PROJECT OBJECTIVE	To support the preparatory training for round one and two update rounds of the HDSS; support training of field staff and data manager; support the training and verbal autopsy(data collection and analysis), update events and troubleshoot on request, the IT database systems as well as suggestions for IT and back-up equipment.

PROJECT PERIOD	January –December 2011

PROJECT TYPE	Establishing a research field site

PROJECT SUMMARY	Maternal and child health indicators in Nigeria are among the worst in the world. Nigeria is ranked second to India in numbers of maternal deaths annually and, together with India, was reported to be contributing approximately one-third of the world’s total maternal deaths. The Nahuche HDSS was set up in an effort to generate evidence base to inform health policy and the selection of appropriate programme strategies to reduce the unacceptably high rates of maternal, newborn, and child mortality. INDEPTH assisted with and advised in the various processes that led to the establishment of Nahuche HDSS such as recruitment and training of staff, field operations, and selected key demographic indicators. While the experiences of setting up a new HDSS site may vary across settings, the experiences in northern Nigeria offer some strategies that may be replicated in other settings with similar challenges
Publication from this experience	Lessons learned from setting up the Nahuche Health and Demographic Surveillance System in the resource-constrained context of northern Nigeria. Citation: Glob Health Action 2014, 7: 23368 - http://dx.doi.org/10.3402/gha.v7.23368 Abstract Background: The present time reflects a period of intense effort to get the most out of public health interventions, with an emphasis on health systems reform and implementation research. Population health approaches to determine which combinations are better at achieving the goals of improved health and well-being are needed to provide a ready response to the need for timely and real-world piloting of promising interventions. Objective: This paper describes the steps needed to establish a population health surveillance site in order to share the lessons learned from our experience launching the Nahuche Health and Demographic Surveillance System (HDSS) in a relatively isolated, rural district in Zamfara, northern Nigeria, where strict Muslim observance of gender separation and seclusion of women must be respected by any survey operation. Discussion: Key to the successful launch of the Nahuche HDSS was the leadership's determination, stakeholder participation, support from state and local government areas authorities, technical support from the INDEPTH Network, and international academic partners. Solid funding from our partner health systems development programme during the launch period was also essential, and provided a base from which to secure long-term sustainable funding. Perhaps the most difficult challenges were the adaptations needed in order to conduct the requisite routine population surveillance in the communities, where strict Muslim observance of gender separation and seclusion of women, especially young women, required recruitment of female interviewers, which was in turn difficult due to low female literacy levels. Local community leaders were key in overcoming the population's apprehension of the fieldwork and modern medicine, in general. Continuous engagement and sensitisation of all stakeholders was a critical step in ensuring sustainability. While the experiences of setting up a new HDSS site may vary globally, the experiences in northern Nigeria offer some strategies that may be replicated in other settings with similar challenges.