Many inhabitants of rural parts of Nigeria do not have access to healthcare facilities and are not able to access the healthcare services they need. To address this issue, the Healthy Beginning Initiative (HBI), a congregation based initiative used to deliver various health interventions to pregnant women and their male partners, was designed to make care more accessible to the people in these low resource settings. The HBI was first implemented in 40 churches in Enugu State, southwestern Nigeria. This program was successful in increasing the rate of HIV testing and treatment for participants as well as sickle cell disease and mental health screenings. The success of the HBI in Enugu led to a scale up in 80 churches located in Benue State, north central Nigeria.
This study looks at the implementation fidelity, the degree to which an intervention is executed as planned, of the scale up in Benue. During the scale up, 16 (20%) of the 80 churches were visited by a two-person team to observe how well the study protocol from the initial program was being followed. These individuals were given a checklist of 26 questions, grouped into 9 domains, to score from 0 to 9. The available data is made up of 30 scored checklists. An implementation science framework was used to analyze the data collected from the 30 scored checklists and to determine whether or not the HBI is simple enough to implement with fidelity.