In Nigeria, a state-level health COP shows the power of convening

July 3, 2018

Reducing diarrheal disease among children is a major goal of the global health community. Although it is both preventable and treatable, it is the second leading cause of death among children under 5, killing more than half a million each year. So in 2013, when Pact launched its ICARE project in Nigeria with funding from the Bill & Melinda Gates Foundation and DFID, we were determined to make the biggest impact possible. 

The ICARE project, or Increasing Care Seeking Behavior for Childhood Illnesses, worked with parents and other caregivers in two key Nigerian states to ensure that as many as possible were seeking immediate care for children with symptoms of diarrheal disease – within 48 hours. We also worked with local organizations and the government to improve the supply of quality health services for children.

Fairly quickly, an opportunity emerged for greater impact that we’d never planned on. The Nigerian federal government was working on a country-wide campaign to boost an initiative to bring locally managed primary health care to families at the community level, called Primary Health Care Under One Roof, or PHCUOR. The Nigerian health system is highly decentralized, and Pact noted that despite all 36 states being directed to implement PHCUOR, they were at very different stages in the process. Pact also noted weak collaboration and communication between states, duplication of efforts and gaps in resources. To help state primary health care agencies improve their functionality and ultimately deliver better health care services to families, Pact decided to launch a community of practice, or COP, among Nigerian state-level health care leaders. The COP concept wasn’t a program deliverable under ICARE, but we believed it could play an important role in helping to reach the project’s goals and in creating lasting progress.

With Pact acting as the secretariat that organized, funded, coordinated and provided technical support to the COP, the group met regularly from 2014 to 2017, with representatives from 12 states at its most active. Meetings were typically two days long, with the first day devoted to state updates and the second to organizational assistance and training.

The group slowly became more cohesive and effective. States unused to collaborating established strong working relationships, learned from each other, gained expert health care information and leveraged their influence to gain additional resources from their individual states. As we hoped, the COP was highly valued by participants and resulted in lasting professional relationships and important progress on health initiatives.

“People don’t come to play politics there,” one COP member, Wakiente Omuobo, Bayelsa State’s public health director, said of the meetings. “People tell it straight to your face the way things are.”

Another member, Manir Hassan Jegga, of Kebbi State, said, “Some things you don’t even know it’s necessary for you to do. But when other states raise it, you think, ‘Wow, this is how they achieved that. Let me try that.’”

A meeting of the COP.

Shelby Wilson, a program officer with the Gates Foundation, said, “Pact skillfully coordinated across a complex and diverse set of partners at the state and community levels to provide the platform for health leaders to share information and best practices and ensure that national efforts to increase care of sick children were successful.”

Unlike we hoped, though, the COP did not become sustainable. The relationships that members formed continue to be of benefit, but the COP no longer meets, mostly because of a lack of funding. The group’s most recent meeting was in November 2017, and no future meetings are currently planned.

Still, we believe the COP can have lasting value, through restarting it if a funding partner can be found, as well as through what we learned; the COP model we used proved successful in many ways and could be replicated in other countries and contexts, even beyond health and capacity development. This is why, with the Gates Foundation, we created and recently published a case study about the COP – a retrospective analysis compiled by an independent consultant that documents steps we took to implement the COP and considers strategies that might enable it or replications to continue sustainably.

The case study also provides deeper insights on our most important learnings about this innovative tool for supporting government systems, including on the power of convening and how it fosters peer-to-peer learning and an enabling environment for joint advocacy and healthy competition, and that the ground is fertile for continued implementation if the COP were to be revived.

We hope other development practitioners find the case study useful and instructive, and we hope it will be shared with governments that might be encouraged to provide such platforms for improved programming. We welcome questions, feedback and opportunities to collaborate.

Download the full case study here.

Ebele Achor is a capacity development advisor at Pact. Reach her at