Significant investment continues to be made to improve the health of women and children across Nigeria, especially in rural, disadvantaged locations. The necessity of investment is especially glaring in northern Nigeria, where maternal mortality rates are particularly high relative to the rest of the country. A deal of effort has been made to improve maternal and child health and interventions continue to evolve to fit our local contexts. Health interventions require, in their design phase to take into account the perspectives of all stakeholders so that they take ownership of projects to ensure sustainability.
In Nigeria's context, traditional and religious leaders are considered influencers, role models, and custodians of spiritual health. These individuals wield significant influence in communities because they are closest to the people, and shape their attitudes and beliefs. Even though some traditional leaders live in palaces in cities, their leadership team ensures information flows from community leaders to district heads to emirs. This means community leaders are the first to learn of their people's problems and usually the first to respond, building trust between these leaders and their people.
Traditional and religious leaders as a result are strategic partners in communicating health messaging to their people and getting people to embrace interventions which would normally have been viewed with scepticism.
Partnering with these influencers in Sokoto State led to the acceptance of the life saving chlorhexidine gel used on new-borns' unbiblical cord, and this is reducing the high burden of neonatal mortality in the state. Perhaps nowhere has the partnership with traditional and religious leaders proven more fruitful than in the drive for the acceptance of polio immunisation in northern Nigeria, where government and partners sought the support of these institutions in persuading people to allow their children to be immunised. This resulted in improved immunisation coverage across the region and contributed immensely to Nigeria's drive to be polio free, a feat that see Nigeria being declared polio free in the next 6 months.
The population in Northern Nigeria is often viewed being conservative, grounded in religious beliefs that often influence behaviour and acceptance of issues such as antenatal visits for pregnant women, facility deliveries and family planning are sometimes viewed with suspicion and not fully accepted, especially in the rural areas. These beliefs also influence the language used to influence behaviour, requiring more socially acceptable terms like "child spacing" rather than "family planning". In a primary health centre in the state of Kano for example, health workers had to refer to child spacing as an approach to improve patronage of family planning services by women in the area. The story is the same in many communities.
The Maternal Newborn and Child Health 2 (MNCH2) project is a five-year UK Department of International Development (DFID) intervention aimed at ensuring women and children in the six northern states of Kano, Jigawa, Kaduna, Katsina, Yobe and Zamfara have access to quality healthcare. It is managed by a consortium of partners led by Palladium, and which includes Society for Family Health, Association for Reproductive and Family Health, Options International and Marie Stopes Nigeria. Dr Jennifer Anyanti, Deputy Managing Director at Society for Family Health, who provided technical support for the project, said the project actively involved project beneficiaries in its execution, including women and community leaders. She said organisations need to look beyond members of their consortia and collaborate with states, traditional, religious and facility leaders to get better results.
To consolidate learnings and ensure sustainability of the project which winds up this year, the consortium partners are using a series of learning events to disseminate findings, build momentum and garner support to improve maternal health in the project states.
The first learning event focused on accountability, says the Project Director, Dr Jabu Nyenwa. This second learning event, held on February 5th, 2018 in Kano State, focused on the role of community leaders to improve maternal and child health. The event provided a peer networking opportunity for community leaders from all the six project states to benefit from the evidence gathered from the project over the past five years.
Delivering a keynote address, the Emir of Kano, Muhammad Sanusi II, posited that the focus of any leadership institution be it government, traditional or religious, is the people because, "whatever affects the people is our primary concern as leaders."
He spoke in strong support of leveraging traditional rulers to reach communities with life saving health interventions as they are gatekeepers and are closest to the people, and so have access to areas where government presence may not yet be felt. Traditional rulers have played a significant role in Kano state especially since the Emirates Council established the healthcare committee. The committee is comprised of district heads, medical professionals and government representatives.
The Emir iterated that issues that lead to maternal mortality must be prioritised especially for young girls because "the fact that a girl can conceive does not mean she can go through delivery process."
The MNCH2 learning event provides evidence that engaging community leaders to improve health outcomes for women and children is a potential game changer for maternal and child health interventions in Northern Nigeria. It is important that government and partners working to improve maternal health indices leverage on the learnings from this and other similar projects to ensure that more Nigerian women and children are saved from preventable deaths.