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How Women4Health reduces maternal mortality through local health providers

At a time when skilled hands shun health facilities in rural communities, Women4Health is filling them up with trained hands from the local communities

Adnanatu and Ummulkhair: Fresh community health workers
Adnanatu and Ummulkhair: Fresh community health workers

By Nabila Abbani

In Northern Nigeria, most rural women are not giving the opportunity to go to school or further their education. They are normally married out below the age of 20, because their parents consider girl-child education less important. And when these young women get pregnant, they usually face many health problems, which results to increased maternal mortalities.

Studies have shown that the North has the highest rate of maternal and child deaths in the country. Many of these deaths can be prevented if skilled birth attendants attend to deliveries. Although 61% of childbirths in Nigeria occur without skilled health workers in attendance, the situation is worse in the Northern Nigeria, where more women deliver without skilled health workers (84% in the North East and 90% in the North West).

However, shortages of skilled health workers in Northern Nigeria are caused by a number of factors including varying standards in pre-service education, poor absorption into workforce (e.g health worker recruitment embargo in some northern states), ineffective deployments, poor monitoring, supervision and regulation to mention just a few.

In 2012, the UKAid funded Women for Health (W4H) programme has been working in five Northern Nigeria states, namely Kano, Jigawa, Katsina, Zamfara and Yobe to increase the number and quality of front-line health workers and support their deployment to rural health facilities, where they can have the greatest impacts in reducing maternal, infant and child mortalities.

Furthermore, in order to achieve these objectives, W4H came up with varying interventions to improve the standard, quality, governance and accessibility of health training institutions across the five programme states.

On 24th of April 2017, the Kano state government in collaboration with Women for Health (W4H) Programme organized an event to celebrate the students graduating in the year 2017 as nurses, midwives and community health extension workers from the programme states, at the Coronation Hall in the Kano State Government House. I was opportune to be invited to the programme. I interacted with some of the graduating students from different states. I wish to share the stories of two ladies, Ummulkhairi from Katsina State and Adnanatu from Zamfara State. They shared their experiences with me, which I believe would serve as lessons to others.

The story of Ummulkhairi

Ummulkhairi is a 22-year old orphan, hails from Katsina State, single and came from a large extended family from Kusada Local Government Area of the State. She stays with her mother and relatives. Her father died before she graduated from secondary school. In her community, girl-child education is however encouraged so far you have the requirements and strong parents to support you. While in secondary school, Ummulkhairi had the ambition of becoming a health worker in her community. So she made sure she read and passed her exams; she got five credits.

When the Women for Health (W4H) programme introduced the Foundation Year Programme to her community, it was warmly accepted because the community had a lot of challenges with regards to maternal health care and infant mortality. Ummulkhairi’s maternal uncle quickly collected her credentials and that of her sister, Zainab, and submitted them for screening.

After the screening exercise, Ummulkhairi was lucky to pass and was given admission in the programme, but her sister had to undergo foundation year programme to be able to write WAEC and NECO. After the 6 months’ studies in the preparatory class, she passed the examination and was given admission to study Midwifery.

One of the greatest challenge she had which almost shattered her dream before she started the programme was when one of her paternal uncles came to her mother and warned her that he heard everything about Ummulkhairi’s going to Kano State for three years just to study. He said, “This is unacceptable and will not happen”. Ummulkhairi overheard their conversion and suddenly burst into tears because she knew him as a very strict person, who has the backing of everybody in his family.

Ummulkhairi’s mother was left with the only option of going to the District Head, seeking his intervention in the matter. The District Head summoned the entire family. “After they all gathered,” Ummulkhairi narrated, “he explained the programme in details to my uncle and everybody present. He further requested that they should please allow me to go to school.” Finally they all accepted but on the condition that every weekend she must come back home and visit them. Ummulkhairi’s mother agreed to their condition and proceeded with the preparations for Ummulkhairi’s study.

“Today being our graduation celebration day, I cannot explain how happy I am, especially when I remember what my lovely mother used to tell me ‘Ummulkhairi, Iam proud of you. Allah will protect you always’” says Ummulkhairi.

Ummulkhairi while in tears thanked the Women for Health (W4H) Programme. “I don’t have words to use to thank you (W4H) for supporting an orphan like me and making my dream come true”. She added that she learned so much about personal hygiene and also confessed that living with other students has truly shaped her life, saying now she can freely interact with diverse people.

The story of Adnanatu

Adnanatu is a 26-year old mother of three from Zamfara State; she is married. She hails from a community in Anka Local Government that does not support girl-child education beyond secondary school. They have only one Primary Health Care outlet which is located very far from their community. Bad road, poor staffing, insufficient facilities and drugs were some of the problems experienced by the community in terms of health care delivery.

The introduction of the Foundation Year Programme in 2013 to Adnanatu’s community by W4H suffered rejection by members of the community for reasons best known to them, though the community leader made it clear that it was by choice and interest; that there was no compulsion at all.

Adnanatu narrates her story as such. “On a fateful day, my husband came in and asked for my SSCE result which I had only one credit; I gave it to him without hesitation not knowing what he was going to do with it. After some weeks he came in and told me that I should prepare myself for an interview. I asked him, ‘Which interview?’ That was when he told me about the programme. He encouraged me to try my uttermost best to make it so that I can become a health personnel in my community.

“The interview went on smoothly. Though I was nervous at the beginning, couldn’t speak very well but I was ok later on. At the end, it was announced that I was through along with two other ladies, one of them is also married,” said Adnanatu.

She mentioned that her husband and her parents were overwhelmed with her success, and pledged their support to her. Adnanatu’s mother took over the care of her kids as she was leaving for Kano State for the first time to commence the Foundation Year Programme.

Adnanatu added that she experienced huge challenges during the Foundation Programme. She found it very difficult to cope with the new environment and on the other hand, she missed her kids and family.

“It was only love, care and encouraging words from my husband that kept me moving,” Adnanatu recalled. “I always remember his words ‘Adnanatu I have faith in you, I know you can make it, please try make us proud in our community’. I took the challenge and God’s willing I passed my final exams and was admitted to study a three year course Community Health to become a Community Health Extension Worker.”

She also narrated that during her first year, she concluded to drop out of the programme, because the studies were becoming more and more difficult than the Foundation programme. On the other side, she began to rethink about disappointing her husband, and losing the prestige she started getting in the community as a potential health worker. “These were the only reasons that changed my mind and made me to concentrate on my studies”. Luckily the teachers also understood the situations a number of students were facing; they gave us special treatments and introduced additional hours for us after official closing hours to help us go over our lessons of the day.

As an adage says, “Anything that has a beginning, surely has an end,” Adnanatu added that “I cannot believe I am about to graduate to become the one and only Community Health Extension Worker in my community.” She thanked the overwhelming support of her husband as well as her parents. She extended her gratitude to Women for Health (W4H) for changing her life and that of her community. She urged parents and community leaders to embrace the programme with both hands because of its importance. And she pleaded for government’s support to health care in the rural communities.

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