Thursday, June 28, 2012

Allowing female CHEWs to ride gender-friendly motorbikes in Jigawa State, Northern Nigeria: a critical step towards better maternal and child health

A gender-friendly motorbike
Nigeria has a disproportionate burden of global maternal mortality burden. About 342,900 women worldwide died from causes related to pregnancy and childbirth in 2008. Three out of five of these deaths occurred in sub-Saharan Africa, and Nigeria alone had an estimated 50,000 maternal deaths thus constituting one of the highest maternal mortality ratios (MMR) in the world. The situation is dire in northern Nigeria, where MMR is estimated to be significantly higher than the national average with recent estimates for the north exceeding 1,000 per, 100,000 live births compared to MMR estimates for the southern region below 300 per 100,000 live births.

Between 2007 and 2008, a Partnership for Reviving Routine Immunization in Northern Nigeria (PRRINN); and the Maternal, Newborn and Child Health (MNCH) Program targeting four states in northern Nigeria (Jigawa, Katsina, Yobe, and Zamfara), was established with co-funding from the Department for International Development of the United Kingdom and the Government of Norway in response to dire health status of women and children.

With the support of the operations research unit for PRRINN-MNCH Program, Jigawa state consequently decided to pilot an adaptation of the Navrongo Community-Based Health Planning Service strategy in Ghana to bring services to especially remote communities. This decision is convergent with the position of the Nigerian Association of Health Workers. The association has recognized the need to ensure that the health system focuses on deploying community health workers to provide basic health services in the communities.

A study was designed to explore the feasibility and outcome of community-based health extension workers (CHEWs) providing essential MNCH services within remote communities in Jigawa State. If the pilot in one Local Government Area in Jigawa showed the feasibility and effectiveness of this model, it can be expanded to other areas in Jigawa, if not to other states facing the same constraints on effective access and utilization of primary health care services. In this way, Jigawa will answer the call by the Nigerian Association of Health Workers, and be able to provide national leadership in systematically introducing innovations to the primary health care system and its effective and efficient use of available resources that appear to be key to making substantive progress towards the attainment of MDGs 4 and 5.

The pilot was conducted in the rural and remote communities of Kadawawa and Takalafiya, with a population of 20-25,000 people each. In each community the CHEWs sought to engage 5,000 women of childbearing age, with a focus on the 1,000 pregnant women and the 1,000 who had children under age 1.

Deploying a CHEW to work and live in a community is one of the interventions that have generally been known to work effectively in many settings. However, deploying such an intervention in a rural setting of Jigawa State and assessing the health system challenges and the capacity to respond to them was one of the key objectives of the pilot study.

While the study generally demonstrated an increase in the uptake of MNCH due to the availability of CHEWs, transport for making home visits especially during the rainy season was one of the challenges experienced during the study. A number of home visits could not be made due to the difficult terrain. Most of these problems were reported to the health administration and efforts to resolve these were made within the limits of the health administration.

Successes and challenges from the pilot study were shared with stakeholders in order to plan effectively for the scale-up. One critical action was the support of the operations research team for the study which made intensive advocacy visits to senior health officials on some of the challenges encountered. The Gunduma Health System Board in Jigawa State, inter alia, obtained approval from the State Assembly to employ more female CHEWs towards the end of 2011. At the time of the study, the Gunduma Health Systems Board had budgeted for more CHEWs recruitment for 2012 and apparently recruitment of female CHEWs will become regular and stabilize.

With respect to transportation, an advocacy visit was made to the traditional ruler, the Emir of Dutse in August 2011, who gave consent to allow female CHEWs to ride motorbikes to implement home visits. The Emir consented to the purchase and deployment of gender-friendly motorbikes in order to address this challenge. Such consent was critical since women riding motorbikes is considered by others within the community and northern Nigeria in general as contrary to sociocultural and religious beliefs. By the first quarter of 2012, 20 motorbikes were purchased and female CHEWs will be trained to ride the motorbikes and use them during the scale-up phase of the intervention. While addressing the MNCH challenges in northern Nigeria is not a here and now matter, allowing female CHEWs to ride motorbikes is a milestone in efforts to provide integrated MNCH services at the doorsteps of the community and this will increase access and utilization of MNCH services in rural areas.

Gender-friendly motorcycles have a step-through space which makes it easier for them to mount the motorcycle than the 'male' motorcycles which have a gas/fuel tank in the middle. Gender friendly motorcycles have a gas/fuel tank under the seat.

Henry V. Doctor
Associate Research Scientist, Population & Family Health
Operations Research Advisor, PRRINN-MNCH Program, Nigeria