A case study of health service provision in Yobe State, Nigeria in the context of the Boko Haram insurgency

Authors: Martina Lembani¹, Abdulaziz Mohammed², Ahmad Abdulwahab², Ashiru Garba², Helen de Pinho³, Peter Delobelle¹, Christina Zarowsky^1,4 & Alastair Ager³

^{1 School of Public Health, University of Western Cape, Cape Town, South Africa
2 PRRINN-MNCH, Nigeria
3 Mailman School of Public Health, Columbia University, New York, USA 4 University of Montreal, Quebec, Canada}

October 2014

Health Systems Resilience: A Systems Analysis was a ReBUILD affiliate research project applying a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity. The project was implemented by the Mailman School of Public Health, Columbia University, in collaboration with the School of Public Health, University of Western Cape.

Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. This 2014 paper is an analysis of the circumstances in the health sector in Yobe state in northern Nigeria, related, and in response to the Boko Haram insurgency beginning around 2011 and continuing to the present.

The paper makes a number of Key Points:

Yobe State faced severe disruption of its health service as a result of the Boko Haram insurgency.

• Population migration and transport restrictions have severely impacted access to health provision . 
• The human resource for health capability of the state has been severely diminished through the outward migration of (especially nonindigenous) health workers and the suspension of programmes providing external technical assistance
• The political will of the Yobe State government to strengthen health provision – through lifting a moratorium on recruitment and providing incentives for retention and support of staff – has supported a recovery of health systems functioning
• Policies of free-drug provision and decentralized drug supply appear to have been protective of the operation of the health system
• Community resources and cohesion have been significant assets in combating the impacts of the insurgency on service utilization and quality
• Staff commitment and motivation – particularly amongst staff indigenous to the state – has protected health care quality and enabled flexibility of human resource deployment
• Systems modelling provided a mechanism to enable stakeholders to articulate a vivid picture of the interplay of key factors seen to influence response to the crisis
• The methodology adopted appears promising for consolidating insights from multiple stakeholders regarding factors supporting – or undermining – health systems resilience

Read the full report: A Case Study of Health Service Provision in Yobe State, Nigeria in the Context of the Boko Haram Insurgency