Salamatu is a young woman in Niger State, Nigeria. Already a mother of three children and pregnant with a fourth, she fears that she won’t get prompt health care when it’s time to deliver because her community health care center does not operate 24 hours. Her voice, and the thousands of others calling for inclusiveness in reproductive, maternal, newborn, child and adolescent health (RMNCAH) issues, falls on deaf ears, as there is no existing platform for citizen-led accountability for MNCH in Niger State, Nigeria.
Citizen-led accountability (CLA) allows community members and Civil Society Organizations (CSOs) to hold politicians and policy makers responsible for the promises they make during electoral campaigns concerning social provisions (health, water & sanitation, electricity, etc.). Citizens become empowered by actively participating in decision-making processes on how the government’s money and donor-funded projects are distributed. Actively participating in decision-making processes for how funds (whether from the government or donors) are distributed for social provisions empowers citizens.
White Ribbon Alliance for Safe Motherhood is a global alliance that aims to unite citizens to demand the right to a safe birth for every woman and ensure that all women realize their rights to be safe before, during and after childbirth. The Alliance works to achieve this mission by providing tools and strategies for citizens to become actively involved in RMNCAH service delivery and decision making in their communities. The alliance also engages government leaders and policy makers to respond to their citizen’s RMNCAH needs.
In line with this vision, White Ribbon Alliance Nigeria (WRA Nigeria) is currently implementing a three-year campaign titled Niger State Citizens Engagement in Reproductive, Maternal, New-born and Child Health, focused on accountability interventions in Niger State, Nigeria. Globally, there have been many success stories on how accountability interventions have improved RMNCAH services.
In 2012, reports from International Planned Parenthood Federation showed that conducting CLA advocacy and budget analysis programs led to receiving more funding for a reproductive and adolescent sexual health and rights program in Mexico.
In 2015, a three-year White Ribbon CLA’s campaign in Uganda resulted in significant improvement in infrastructure, health worker recruitment and the availability of lifesaving commodities. As a result, women reported improved access to life-saving services closer to their homes and district officials also commended White Ribbon Alliance Uganda for bridging the gap between citizens and policy makers and strengthening the health system to better respond to community needs.
In the world, according to UNICEF, every single day Nigeria loses 145 women of child bearing age, making Nigeria the second largest contributor of maternal mortality in the world. According to the World Bank, in Niger State, Nigeria, only 30% of pregnant women are attended to by a skilled birth attendant and only 25.3% deliver in a facility. According to the United Nations Economic and Social Commission for Western Asia, the state has a maternal mortality rate of 130/100,000 live births, under-five mortality of 103/100,000 and infant mortality of 260/100,000 live births.
Many causes of maternal, newborn and child mortality are preventable using an evidence-based and cost-effective set of essential interventions.
WRA Nigeria uses several approaches.
As a start to the advocacy campaign, WRA Nigeria will carry out a ‘know all citizens’ tour. WRA Nigeria will go to the communities that are most affected and engage with citizens and traditional leaders to identify the problems first hand and how well WRA Nigeria can approach the situation. Previous campaigns show that change is most successful when the people affected know their rights and how to affect change through the appropriate channels. So far, WRA Nigeria has engaged over 3,000 citizens who are demanding to be involved in decision making for their health.
After the tour, WRA Nigeria will begin to amplify citizens’ voices through media and champion engagement. They have trained local journalists present in the communities to identify human angle stories on challenges communities face in accessing and using RMNCAH services. This training provides exposure for realities of RMNCAH issues in the community. It offers policy makers evidence for intervention and citizens the basis to increase demands for improved services.
In Niger State, Nigeria, WRA Nigeria’s approach has proven effective through the Ward Health Development Committees (WHDCs), which are citizen engagement platforms in local communities. Evidence abounds that the WHDCs are active in communities but function sub-optimally for routine immunization only. WRA Nigeria is working to build capacity of these local platforms for improved monitoring and feedback to health providers, policy makers and the public and to expand their roles to include all aspects of RMNCAH and primary health care in select areas of the state.
The campaign has not been without its challenges, including initial distrust from the state government of the campaign and its tactics. Trust was built, though, by working closely with state government. On the part of the citizens, there was a high level of doubt and anger toward the government. Many of the citizens felt left behind and forgotten by the state government, leading to resentment. WRA Nigeria’s work and position is critical to address issues of mistrust and resentment and to improve RMNCAH in Niger State, Nigeria.
By the end of the three-year campaign, CLA for RMNCAH, WRA Nigeria’s intervention in Niger State will improve the quality of RMNCAH services and care delivery, balance manpower distribution in the Primary Health Care System, strengthen platforms for engagement and build a sustainable feedback loop in the community.
By the end of the campaign, we hope that Salamatu and millions of women in Nigeria will not only have their voices heard, they will be active leaders in RMNCAH decision making.