Assessment of routine facility-based monitoring of quality of reproductive, maternal, newborn, child, adolescent, elderly health and nutrition services in Cross River and Rivers States, Nigeria: cross-sectional study

Nigeria, like other sub-Saharan African countries, faces significant challenges in efforts to improve the quality of reproductive, maternal, newborn, child, adolescent and elderly health and nutrition (RMNCAEH + N) outcomes. This study assessed the quality of data collection and utilisation for quality improvement (QI) in reproductive, maternal, newborn, child, adolescent, and elderly health plus Nutrition (RMNCAEH + N) in Cross River and Rivers States, Nigeria. The study was a cross-sectional mixed-methods study that used checklists and a semi-structured questionnaire to assess collection, analysis, and use. The study employed a multi-stage sampling approach across Cross River and Rivers states. Researchers used Probability Proportional to Size (PPS) and random sampling to select 21 LGAs and 165 health facilities. Participants, including facility heads, healthcare providers, M&E officers, gatekeepers, and state/LGA officials, were purposively and randomly selected based on their roles and geographic location. Quantitative data were collected using structured questionnaires and facility checklists (Tools A–F) via SurveyCTO on Android tablets. The resulting quantitative data were analyzed using tables and figures to evaluate health system resources and evidence-based decision-making capacity. Qualitative data were digitally recorded and supplemented with field notes. Researchers transcribed the interviews and applied a two-level coding tree, utilizing the WHO health system framework for initial categorization and perceived barriers or facilitators for secondary themes. Findings were then synthesized across facilities and reported using a tabular format featuring representative exemplar quotes. Ethical approval was obtained from the State Ethics Committees of both States and the IRB of the University Teaching Hospitals. District Health Information Software 2 (DHIS2) is widely deployed in most PHCs and is being used for routine monitoring and evaluation (M&E) of RMNCAEH QoC in both states. Completeness of RMNCAEH QoC data reporting at the local government level was good in all PHCs but lower in secondary public and private health facilities. Timeliness of reporting was generally poor across all categories of health facilities (HFs), with significant variation across facilities and states. Implementation of RMNCAEH QoC M&E is evident from the findings, but there are significant gaps in basic infrastructure, Health Information System (HIS) tools, and human resources. RMNCAEH QoC data are being used in decision-making, but the use was generally low and varied. Routine monitoring of the provision-of-care domains of QoC currently receives most attention. In contrast, very little attention is paid to monitoring QoC domains that address the experience of care. The assessment demonstrates that the deployment of HIS is feasible for routine monitoring of RMNCAEH, but with suboptimal performance and implementation efforts in most of the assessed health facilities. Lack of basic infrastructure, HIS tools (hardware and software), and human resource capacity are fundamental findings that need to be comprehensively addressed. Strengthening the capacity of health facilities to monitor QoC domains related to the experience of care should be prioritised.