Government-Led Scale-Up of Adolescent Contraceptive Programming: Evidence from Routine Health Information Systems in Nigeria and Ethiopia

Background: There is limited evidence on the effect of scaling adolescent sexual and reproductive health (ASRH) interventions on routine health facility reporting and service delivery. We assessed the effects of scaling up Smart Start in Ethiopia and Matasa Matan Arewa (MMA) in Nigeria on facility reporting and contraceptive service utilization among married adolescent girls aged 15–19 years.

Methods: We conducted a retrospective longitudinal panel study using routine government health management information system (HMIS) data from January 2021–December 2025 in Nigeria and January 2020–December 2025 in Ethiopia. Analyses were conducted at the facility-month level, covering 102,750 facility-months from 1,713 Nigerian facilities and 692,543 facility-months from 9,619 Ethiopian facilities. Linear probability models assessed changes in facility reporting, while Poisson pseudo-maximum likelihood models with high-dimensional fixed effects estimated changes in monthly contraceptive visits. Analyses compared pre- and post-activation periods, examined scale-up phases, and assessed within- and neighboring-district activation intensity.

Findings: Scale-up was associated with significant improvements in facility reporting in both countries. Post-activation reporting increased by 5·1 percentage points in Nigeria and 8·0 percentage points in Ethiopia. Contraceptive visits also increased following activation. In Nigeria, visits were 6% higher after activation (IRR 1·06, p=0·03), with gains sustained across maturity phases. In Ethiopia, visits were 71% higher after activation (IRR 1·71, p<0·0001), with sustained increases across all scale-up phases. Effects in both countries remained robust when adjusting for intervention rollout in neighboring districts; in Nigeria, the estimated effect of the program at individual facilities became smaller after accounting for the proportion of facilities within a given district which had also begun implementing the intervention.

Interpretation: This study found that government-led scale-up of adolescent contraceptive interventions in Nigeria and Ethiopia improved health facility reporting and contraceptive service utilization. Gains were strongest during early implementation and generally sustained over time, demonstrating that adolescent-responsive interventions can be successfully integrated into routine government health systems. Results highlight the importance of early technical assistance, adaptive support models, and context-specific strategies for sustainable scale-up of ASRH interventions.