27 August 2018

Nigeria: Can Community Organisations Lead in Taking Sexual Health Education to Rural Areas?

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As the nation's seat of power, the Federal Capital Territory (FCT) is usually associated with splendour. This opinion about the city is often formed by the images of wide roads and beautiful structures in the city centre and Abuja's plush neighbourhoods and from images on social media. But for some who live in Abuja and care to go beyond the city limits to visit communities on the outskirts of Abuja, there is more to Abuja than initially meets the eye. Some of the communities are less than an hours drive from the FCT, yet lack some basic social services such as schools, electricity, healthcare centres, markets and proper waste disposal systems. Access to healthcare is financed mostly through out-of-pocket payments and local communities are sometimes dependent on periodic free medical outreach programmes from non-governmental organisations. Waru and Orozo are two of such communities.

How a community mobilises for Youth Development

About 26km from Abuja city centre, Waru community is located in very close proximity to the popular and busy Apo Mechanic Village. Driving past Apo, the long stretch of road leads you to communities in Abuja that have been overlooked by the state's government, as the hustle and bustle of the city slowly disappears. The major mode of transportation between the mechanic village and the Waru community is motorcycles or tricycles popularly called 'Keke Napep'.

The community appears peaceful and is populated mainly by indigenous Gbagi families and internally displaced persons fleeing the Boko Haram insurgency. It is led by a district head who doubles as the community chief. Waru has a terribly under-equipped and under-resourced primary health centre and no senior secondary school. Young people in the community attend the secondary school located in Apo.

The lack of a senior secondary school means there isn't a formal and organised system to reach young people with accurate sexual and reproductive health information. This appears to be one of the reasons for the high rates of teenage pregnancies and dropouts from schools.

Waru is home to 17-year old Blessing Nzerem who lives in the community with her parents and three brothers. Although she has completed her secondary school education, she has no plans of proceeding to university because of lack of funds. She works in the community as a volunteer with the Youth Advocate for Sustainable Development (YAFSD), a Community-Based Organisation (CBO). The CBO was founded by "trained community mobiliser" Ayo Adegbola and is co-run by his wife, Agnes and daughter, Peace. Blessing says her role as a peer educator excites her because it gives her the opportunity to transfer knowledge about sexual and reproductive health to her peers, who she feels are usually misinformed about sexual and reproductive health.

Adegbola has always been passionate about community development. He works with his wife and daughter. His daughter has completed her secondary school education and "helps with the writing," he said. His wife helps with logistics when they have programs. YAFSD mobilises young people in the community for interventions aimed at providing comprehensive sexual and reproductive health education and services.

Ayo Adegbola has been in the Waru community for less than 12 months, but made quite an impact on the youth in the community. Nearly everyone in the community knows him and his family. While standing with him near the small community market, he is greeted by dozens of people and points out young people that have benefited from some of his organisation's interventions. Sixteen-year-old Tumu Elimelech is one of them. Tumu is in his first year of senior secondary school and said he still has sessions with his peers where he shares the knowledge about sexual and reproductive health he acquired during his training with the CBO.

As soon as he relocated to Waru community in 2017, he established a relationship with the community chief. Since then, he has held a series of events targeting young people and other members of the community. These events have been funded by simply reaching out to friends who reside in Abuja for support. He has built credence over time and his work is now supported by organizations such as Youth Hub Africa, Connected Development, Vaccine Network for Disease Control, Society for Family Health, and AIDS Healthcare Foundation among others.

Onyinye Edeh arrived in Nigeria on June 26th, 2016 as part of her two-year fellowship with the Institute of Current World Affairs (ICWA). With a background in public health, the purpose of her fellowship was to research, and document development issues faced by young girls. She started the Strong Enough Girls Empowerment Initiative (SEGEI) as a response to some of the challenges she discovered during her fellowship. Her work is primarily based in rural and often hard-to-reach communities because "that is where you see real vulnerability," she says. She has also leveraged her strategic networking and mobilisation skills to form a team of passionate volunteers and partnered with Mr. Adegbola to educate young people in the Waru community.

SEGEI's intervention in the Orozo community involved empowering young people to develop community approaches to HIV prevention. "We achieved this by building in the sensitisation of young people aged 13-24, in and out of school during a SEGEI-sponsored football match," said Jolaoluwa Aina, the program manager. At the end of the training, the peer educators were given handbooks to guide future peer sessions.

Simple efforts, yet profound impact

Blessing and Tumu are just two of many young people in these two rural communities that have benefitted from the work of YAFSD and SEGEI. Also, working with her father has provided Peace opportunities to benefit from numerous training and mentorship programs. She now mentors young girls in her community, every Saturday. This year, she was the youngest speaker at the Commonwealth Women's Forum where she had the opportunity to address leaders from 53 countries within the Commonwealth and brought their attention to issues faced by young girls in her rural community.

Blessing has been able to correct some of the misconceptions she had about Sexually Transmitted Infections (STIs), including understanding the dynamics of antibiotic resistance. "Although I knew about toilet infections, I used to think HIV and some other sexually transmitted infections can also be acquired this way... When my friends come to school with signs of an infection, they usually claim it's from toilets and not from having unprotected sex. They visit pharmacies and get antibiotics and when the symptoms relieve, they stop taking the medications", she said. But she knows better now. "We were taught that this is bad because when the infections return, it becomes stronger and the medication will not work again." Blessing said she used to be afraid of getting close to someone living with HIV, but the training opportunities have helped her learn more about HIV transmission.

Adegbola's community mobilisation skills have attracted a lot of community interventions and projects to the Waru community, including the visit of the United Nations Youth Envoy, Jayathma Wickramanayake, when she came to Nigeria in February 2018. Three schools in the community have become his partners with a pledge to support his work by providing access to their space and facilities at no cost. To encourage Adegbola's work, the District Head of the Waru community, Ibrahim Saraki, also donated a building in the central area of the community to serve as his office.

Overcoming challenges

While Adegbola is aware that depending solely on grants from donors is not sustainable for running his organisation, financing his activities from personal funds isn't either and this remains a major challenge for his work. Sometimes, his efforts are questioned by overzealous members of the community and are often viewed with suspicion. He says this can be discouraging, "because you are only trying your best to do what you can to help the community".

Another challenge Adegbola faces in his work is the wrong perception members of the community have about how the development community operates. "A lot of them believe it's all about money and don't understand why people who don't know them would want to help them." His daughter Peace meets with young girls in the community every Saturday to share experiences about reproductive health and life skills. They had challenges at some point because the participants expected her to bring refreshments at every meeting.

The intervention by Edeh and her team at SEGEI also faced similar challenges when some of the community peer educators participating in their training started requesting for incentives. "More so, their peers who they were educating were also asking for incentives," Aina said.

Securing the future by improving investments in adolescent health

It is easy to replicate what Adegbola and Edeh are doing by selecting and training young people with community mobilisation and networking skills. However, in order for this to happen, there needs to be the political will and a firm resolve to actively harness the potential of Nigeria's teeming youth population, or the so-called "demographic dividend". This year, Nigeria's population hit 180 million and more than half of this population is under the age of 30.

There is still so much talk about harnessing demographic dividends, which is described as "the economic benefit a country gets from a change in population age structure". But this "dividend" does not come automatically and will only be achieved where a country prepares effectively to reap these "demographic dividends" One of these preparatory investments is in the human capital of the young population. Bill Gates gave a tough talk to the Nigerian leaders when he visited in March and stated that the Economic Recovery and Growth Plan (ERGP) over-prioritised infrastructure over human capital in its execution priorities.

He was criticised for this but in an interview with CNN, Gates restated the low prioritisation of investment on issues affecting young people. "As a partner in Nigeria, I am saying the current plan is inadequate. Nigeria has all these young people and the current quality and quantity of investment in these young generations, in health and education, just isn't good enough," he told CNN.

This lack of political will for effective investment is evident in the 2018 appropriation bill with only one line item directly focused on adolescent and elderly care. Advancing adolescent healthcare, elderly healthcare and well-being projects in Nigeria is allocated a paltry sum of N2,990,663. How far can this go? What can this deliver for young people in Nigeria, especially in hard to reach rural communities?

The Gender, Adolescent School Health and Elderly Care (GASHE) division under the Family Health Department of the Federal Ministry of Health is charged with the responsibility of addressing issues around adolescent sexual and reproductive health. A staff member in the GASHE division, who asked not to be named stated that the right policies are in place, but what is lacking is the political will and commitment to invest in the implementation of the policies.

"We recently concluded a situation analysis of issues facing young people in the country and will be convening all adolescent health desk officers in states and other organizations working on these issues for a meeting," the source revealed.

The theme of this year's International Youth Day makes a case for "Safe Spaces for Youth." According to the United Nations, youth need safe spaces where they can come together, engage in activities related to their diverse needs and interests, participate in decision-making processes and freely express themselves.

We need more safe spaces such as those created by Edeh and Adegbola for young people in Waru and Orozo communities. It costs almost nothing to achieve, but leadership and a strong resolve is needed so that Nigeria's young population is able to prosper and become productive enough to add meaningful value to the country and they are better placed to support themselves and their dependents.

Do you know any Community-Based Organization involved in sexual health education in Nigeria? Let us know in the comment section below.

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