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Improving Maternal and Child Health with the Help of Traditional Leaders in Northern Nigeria

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Improving Maternal and Child Health with the Help of Traditional Leaders in Northern Nigeria Case Study No. 8 | December 2017 Improving maternal and child health with the help of traditional leaders in northern Nigeria 1 The Maternal, Newborn Despite recent improvements, health Since the very beginning of the and Child Health indices in northern Nigeria remain programme, MNCH2 has worked Programme in unacceptably poor. The delivery of with traditional leaders to promote Northern Nigeria (MNCH2) is a UK quality health services faces a multitude reproductive, maternal, newborn child and government-funded of problems such as inadequate health (RMNCH) best practices among the five-year programme funding and infrastructure, which are community and decision makers. The close designed to improve compounded by deep-seated socio- relationship that MNCH2 has fostered with maternal and child cultural and traditional beliefs and traditional leaders across the intervention health across six states – Jigawa, practices that hinder both delivery and states has resulted in the engagement Kaduna, Kano, access to health services – especially in of over 2,300 traditional leaders at Katsina, Yobe and relation to maternal and newborn health. the Emirate, District, Ward and Village Zamfara. Across the six MNCH2 intervention levels. This engagement includes formal states, socio-cultural cues and behaviours sensitisation of all Emirs and an average are taken from traditional leaders. These 92%1 of all traditional leaders reached leaders are the custodians of culture and across the six states. traditions, they are at the core of society, the community, and people’s daily lives. The lessons learned from the pro-active KATSINA ZAMFARA nature of these leaders in the fight against 242 238 polio in northern Nigeria show promise 2,104 JIGAWA 134 for engaging them in the efforts to reduce THE NUMBER OF TRADITIONAL LEADERS – EMIRS, DISTRICT KADUNA maternal and child mortality rates, which 414 AND VILLAGE HEADS – YOBE currently rank among the world’s highest. FORMALLY TRAINED AND/OR 294 SENSITISED ON RMNCH Due to their strong role and ability to speak KANO ISSUES BY MNCH2 ACROSS 782 directly to even the hardest-to-reach, the THE SIX INTERVENTION STATES MNCH2 programme recognised the need SINCE DECEMBER 2014 to engage traditional leaders as a priority. 1 Traditional leaders engaged by MNCH2 include Emirs, Chiefs, District Heads, Village Heads and Ward Heads; 100% 1 NTL –MNCH2 and Cross section of traditional of traditional leaders have been reached in Kano State and leaders during their engagement with MNCH2 Kano 100% of District Heads have been reached in Katsina State. The Emir of Daura in Katsina State, alongside The impact of traditional leaders is evident at other Emirs in the MNCH2 states, has shown and each level of decision making and in the patriarchal spoken of his support for working with MNCH2 society of northern Nigeria; this provides a trusted and for sustaining and furthering the progress made and influential platform for directly engaging men to date on RMNCH in his state. on important issues such as RMNCH. This is one important area where MNCH2 has worked with “ We will support this great organisation traditional leaders to inform men of their roles and to pass all necessary information to our responsibilities in ensuring their wives and children subjects across this kingdom, in order to are properly cared for and able to access health care improve the lives of pregnant mothers with granted ‘standing permission2’. and their babies. Myself, District, Ward, To help deliver these important messages to Village Heads and Council Advisors will the community, MNCH2 has, in partnership with be fully involved. The emirate will go a traditional leaders, developed and revitalised male long way in mobilising the communities support groups. Traditional leaders have played a to understand the MNCH2 programme key role in making this happen with the selection and its efforts to ensure women have safe and recruitment of male support group facilitators. pregnancy and delivery. My emirate owes In Jigawa State, for example, 162 male support appreciation to this organisation as you groups have been activated/engaged by traditional are supporting in saving and improving leaders since December 2014. the lives of pregnant mothers, newborns and children in our communities.” " I personally take up the challenge as – Alhaji Farouk Umar Farouk (CON), the custodian of culture to direct my Emir of Daura. community leaders to work with health care providers in improving health-seeking Traditional leaders in the community behaviour. In fact, I will charge them to Traditional leaders are community leaders in ensure periodic visits to the hospitals in northern Nigeria; they include Chiefs, District, their domain for updates from the health Village and Ward Heads who are all under the workers and transmit same to me."3 leadership of the Emir. Traditional leaders are – Alhaji Jamilu Sashir Sanusi, Turakin Dutse the gatekeepers to the community. Prior to (District Head of Dutse, Jigawa State). the commencement of MNCH2 work within a community, an advocacy visit is paid to the The role of reaching out to the community doesn’t traditional leaders; this ensures the MNCH2 team stop with men, traditional leaders have been is able to work within the community and with its instrumental in the engagement of Traditional Birth institutions without hindrance. Attendants (TBAs). In Kano State, over 7,600 TBAs The Emirs and District Heads, unlike other public have been engaged on RMNCH issues by traditional servants, do not exercise any political power, but leaders; the Kano Emirate Council Committee rather are the custodians of culture and advise the on Health (KECCOH) has engaged these TBAs, Government on traditional and religious affairs. of which 560 are MNCH2 trained volunteers as Each state has a slightly different structure for members of the Community Women and Child the traditional leaders, which means the that the Survival System (COMWACSS). These TBAs work MNCH2 State Teams must adapt their approach in their communities to increase awareness on health in engaging these leaders. For example, Kano State services and encourage parents to vaccinate their has one Emir, whereas Zamfara State has 17 Emirs. children and to use health services. Traditional leaders have also worked with STATE EMIRATE STRUCTURE MNCH2 on reaching remote and underserved communities by requesting outreach services, such as in the Albasu Local Government Area4 where 113 EMIR women received family planning products and 257 women were provided with antenatal care services. DISTRICT HEADS 2 Standing permission means that men/husbands have given their wives permission to go to the clinic/facility/hospital to access health services, VILLAGE HEADS and in particular maternal and child health services, without having to seek permission each time. This is important as men/husbands may not be immediately accessible when services may be needed. 3 Stated at the sensitisation retreat on MNCH issues November 2016. WARD HEADS 4 Located in Kano State 2 Case Study No. 8 Traditional leaders – creating a cultural and political shift …We acknowledge the contribution of The traditional leaders work closely with the MNCH2, particularly on health facility state governments to ensure that policies enacted provide the necessary support to meet the specific renovation and creation of a demand needs of their Emirates and communities. generation community structure. To work more closely with the traditional leaders in the MNCH2 states, the programme We pledge to continue and sustain holds traditional leader retreats and workshops the good work that MNCH2 is doing in each of the six states with Emirs and District through the community leadership…” Heads, in addition to the ongoing engagement with traditional leaders through other programme – Alhaji Mahmud Godoron Kurya, activities. The retreats seek to gain the leaders’ Uban Kasan Madaro, Kaura LGA, Zamfara State; support to influence their community in assisting 14 November 2016 women and children to access quality RMNCH services, especially in the rural communities. Those in attendance go beyond the traditional leaders men, lack of awareness amongst the population, to include: State Health Commissioners, senior shortage of skilled medical staff and supplies, as State Ministry of Health officials, State Primary well as inadequate monitoring and supervision Health Management Board/Agency members and mechanisms to track progress. representatives from other related state ministries such as the State Ministry for Local Government Traditional leaders committed and Chieftaincy Affairs. to reducing maternal The state retreats incorporate updates on the and child mortality work MNCH2 is conducting in the states, such The commitments made by traditional leaders, as the renovation of health facilities, provision during each state retreat, have shown a shift in of free MNCH commodities, training of health mindset. For example, it previously would have care workers, and include information about the been unprecedented for some of these leaders importance of the ability for women and children to effectively encourage the use of contraception to access RMNCH services. methods or to be the champions of delaying The dialogue at the retreats explores the marriage. These commitments serve to act as challenges faced by each state in relation to recommendations for the future on how traditional access to RMNCH services, including attitudes of leaders can drive change in northern Nigeria. 10 commitments
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