PATHS2 In Motion A photostory of PATHS2 activities National /October 2010

Ask ...Naija health talk Rolls out in four states “The voice of the people is louder than the boom of a canon” African proverb Ask Nigeria is a community-based public health Focus of Ask Nigeria Pilot dialogue process Primary Focus: A campaign to ‘Ask Nigeria’ what it that offers an knows, thinks and feels about issues opportunity for to do with malaria and pregnancy Secondary Focus: community To learn about the barriers and motivations to change, the role that the health services should play and members, service to apply these knowledge to motivate behavior change among providers and the target groups media to be part of lively and engaging Contents discussions about Introduction- Ask Nigeria 3 health. Background 6 Process 11

Partnerships 14

The voices 18

Special thanks 21

About PATHS2 22 4 Paths2 In Motion

INTERLUDE

“Please let’s call a spade a spade! Let us be fair to ourselves…we need to change our attitude. Tell us more about family planning. How do we access the services?"

Abubakar, A community Leader Group Discussant, Local Government, Paths2 In Motion 5

A isha and Abubukar are just two out of the over 2,000 community persons who were opportuned to ask important questions about their health and get life-saving answers at the PATHS2 supported Ask Nigeria public health dialogues.

“I am 24 years old; this baby you are seeing is the eighth. Whenever I am pregnant, I always suffer especially during delivery…I need advice on how to take care of myself.”

Aisha Duru, Duru Community Discussant, Dutse Local Government, Jigawa state 6 Paths2 In Motion

Background

I n eight urban and rural communities in Nigeria, a community-based health opinion poll was conducted. The findings from the opinion poll were used as background for engaging community members in discussions about the prevention, treatment and care of malaria, pregnancy and other health issues. Community women at Ndeaboh, Enugu state singing and dancing to a malaria song during the sensitization meeting

Cross section of young boys, some of who are already married, participate actively in the Community dialogue Paths2 In Motion 7

Ask Jigawa team member conducting the opinion poll on a woman during the Barriers to health were house-to-house polling process in Jigawa. discussed, knowledge about what is needed to change attitude and develop good practices were impacted and together over 2,000 people attempted to find common solutions to public health issues raised as it affects them either as individuals or as a group.

They went back home ‘informed’ and with a sense of personal responsibility and accountability towards their health.

Children engaged in a question and answer session on basic hygiene with the Ask Jigawa Media Team during the Community Dialogue

Even in the farms, their opinion counts. A male respondent being polled on Ask Jigawa Team conducting polling key health issues in front of his farm to people right in the farm in Jigawa in Jigawa state 8 Paths2 In Motion

W ith active support from the state different groups of participants health ministries, media and non- which include women of governmental organizations, over 28 reproductive age, men, adolescents public health dialogues a.k.a (male and female), health workers, Thematic Community Participatory mothers-in-law and gatekeepers like Group (TCPGs) were held with traditional and religious leaders.

Ask Nigeria team holds intensive discussion on interviewing techniques during Training of Trainees

A planning meeting for A Planning meeting for Ask Nigeria Ask Nigeria roll out, roll out, Abuja Abuja Paths2 In Motion 9

The array of participants demonstrates the Ask Nigeria populist approach whereby people are expected to have a say in issues that affects their health. Participation of the socially excluded like the physically challenged in the group discussions was a mandate and the A cross section of participants including women were actively the physically challenged at the mobilized for the community dialogue in Ndeabor during dialogues. the Ask Enugu process

A community woman, with the help of her family, shares her experience....with the Ask Jigawa team

Ask Nigeria initiative was informed by the critical need to reach and actively engage Mothers-in-law during the community dialogue in Ndeaboh. “Our mothers- in-law” was the chorus answer given by the women of child bearing age the socially excluded in public when asked what to mention one major factor that prevents them from health discussions. going to the health facilities during pregnancy They are often the most affected because they are poor, marginalized and majority of them live in distant hard to reach areas. Millions of our targets do not have access to the media and when they do, they do not have the opportunity to contribute to or Ask Kaduna Intern, Ahmed Sani, Department of Mass Communication, Ahmadu Bello University, Zaria, facilitates the Community Dialogue have a say in health session with a group of fathers in Wuciciri community discussions. 10 Paths2 In Motion

I nterestingly, the community engagement level was not the end of it all! The public health dialogue activities were recorded for broadcast. The purpose was to publicize the community-level discussions in other to deepen the impact through wider participation. Ask Jigawa Media Team ready to take off for the polling in Jigawa

The broadcast will also contribute to the dissemination of knowledge about health to a large heterogeneous group of people and will parade a bottom-up approach for health promotion whereby the people themselves become the source of information. The media is also expected to bring the public

Ask Nigeria Media Team testing their health issues to the attention equipments and machines before going of policy makers and thereby out to the field for the media capture of Ask Nigeria make them to be more responsive.

Akim Mogaji, Ask Nigeria Media Adviser explaining the concept of capturing the Ask Nigeria process to other members of the Media Team

Farad Painchun, an International Media Production Specialist, conducts hands –on training for the Ask Nigeria media team on how to capture relevant and compelling footage from the pilot process Paths2 In Motion 11

The Process

T he Ask Nigeria pilot process commenced with opinion polling in the communities. Four hundred people were polled for basic Mother-in-laws during the community dialogue in Ndeaboh. “Our mothers- knowledge and practice in-law” was the chorus answer given by the women of child bearing age towards malaria and when asked what to mention one major factor that prevents them from pregnancy. going to the health facilities during pregnancy

The polling provided sound community-level quantitative data about the themes. Moreover, community members with peculiar health service delivery issues were engaged through a content research process to learn from their stories and to link Group of young girls in Kaduna state enjoy the drama presentation on dealing with puberty them up to available health before the commencement of the Dialogue services.

A community woman, with the help of her Laure, a woman who has had several family, shares her experience....with the Ask miscarriages and still births, recounts her Jigawa team experience to the Ask Kano team 12 Paths2 In Motion

Still in the same communities, different groups were mobilized for public health dialogues in form of community meetings. Many of the discussions kicked off with short drama presentations. Available to support the discussions were public health specialists and counselors.

The public health specialist corrected myths and provided accurate information on key health conditions discussed while the counselor supported people who are finding it hard to talk about or deal Ask Jigawa Media Team members capturing the voice of with particular health women in Jigawa during the challenges. polling process

The dialogues were rounded up with a question and answer section on general health and well being issues followed by free medical consultations.

A young girl takes time out of her farm work to respond to the polling questions on key health issues during the Ask Enugu media polling Paths2 In Motion 13

Media Polling team for Ask Enugu move into the farms to interview respondents

One of the Interns for Ask Jigawa process administering Gloria of Community Health Research, polling question during the polling process in Karnaya conducts opinion polling on key health community issues on a group of community women in Kunchi community 14 Paths2 In Motion

The Partnerships

W e were not alone in all of these. The successful roll out of Ask Nigeria process pilot will not have been possible without the invaluable support of community

gatekeepers like the Commissioner of Health Jigawa State, addressing traditional rulers and the the Emir of Ringim when he led the Ask Jigawa religious leaders. team on Advocacy visit to the Emir Ringim

The religious leaders were not left out in the polling process of Ask Enugu. Many respondents attributed their not attending health facilities to their religious belief

Ask Jigawa Advocacy Team with Emir of during one of the Advocacy visit to traditional/religious leader on Ask Nigeria Paths2 In Motion 15

Ask Kano Medical Team attend to a Ask Nigeria enjoyed the young female discussant of the tremendous support of the community dialogue event in Shuarki state ministries where we community, Kano worked. For example, in Kano, Ask Nigeria was adopted as the State Ministry of Health Communication Strategy to achieve the Millennium Development Goals (MDGs).

Ask Jigawa Medical team defy rain to We equally worked with render outreach services and advice to the community selected NGOs/CSOs/CBOs all through the process, from the baseline study to advocacy and promotion, to opinion polling and the public health dialogues. They supported the work with community mobilisation and engagement skills.

“Ask Kano will be the driving force to support the Kano State Government to be transparent and accountable, while encouraging the population to ask for their rights and entitlements in a context of good governance”. Alhaji Tajudeen Gambo, Dr. Abubakar Izge, PATHS2 Kano STL, arrives Shuarki community (the venue of the Permanent Secretary, Kano Ministry community dialogue) with the SMoH Ask Kano Medical Team to render free of health medical services to community dialogue participants 16 Paths2 In Motion

“Ask Kaduna has widened my horizon A sk Nigeria partnered to know beyond what is taught in school to the nitty-gritty of with selected higher development challenges in rural institutions under the Nigeria and the role of change agents. If possible, more interns should be Ask Nigeria Internship incorporated so as to allow more scheme designed to students benefit from it.” support students with Ahmed Sani Faki, Mass Communication Department, firsthand practical ABU, Kaduna knowledge of health promotion on the field. “My area of interest is maternal health and I am proud to be involved in Eleven interns worked educating the community on health- with the NGOs and their related issues as part of the Ask Kano team. I want to learn more about academic supervisors communications and information during the pilot. gathering so as to be able to apply them in other aspects later in life.”

Faiza Lawan Mohammed, Community Medicine Department, BUK, Kano Paths2 In Motion 17

The media was a key partner during the pilot. Our media partners in the electronic media include; FRCN Enugu, NTA Enugu, KSMC Kaduna, DITV Kaduna, JBC Jigawa and radio Kano.

We look forward to their more active engagement in the Ask Nigeria process as they will take the lead in organising the Media-led State Debate on Specific Health Entitlement Issues.

It will be a forum for engaging policy makers and T he collaboration apart from serving as a the political class on health good platform for social responsibility entitlement issues raised function of the media will also create a sense from the public health of ownership of the process, thereby giving dialogues. The debate will be the event all the media hype and visibility highly interactive and that it deserves and the likelihood of a live incisive – watch out! broadcast of the event. 18 Paths2 In Motion

Ask Nigeria Ask Nigeria was piloted in each State under the different brand names of Ask Enugu, Ask Jigawa, Ask Kaduna and Ask Kano which was adapted to reflect the specific requirements of each of the supported states.

“After attending the meeting, “I learnt a lot from the event. I certain small containers that used to hate sleeping under collect rainwater in my mosquito nets because I feel compound were thrown away restricted under the net. But I when I came back from the learnt that it is safer to sleep meeting because they told us with the nets because it how the female mosquito prevents malaria infection. The breeds in them, so I threw all benefits outweigh the of them away and cleared the discomfort”

whole compound because of Male Discussant, Jigawa fear of that female mosquito” Female Discussant, Enugu Paths2 In Motion 19

Ask Nigeria gives voice to Mariya and Fatima to tell their stories...

Fatima shares her story with an Ask Kaduna content researcher

My name is Fatima Isa. I live in in law always gave them the herbal Tudun Wada in Tudun gangare. I treatment at home. “The tradition in the house have 6 children, 3 girls and 3 boys. is, we are not allowed to We live in this family house with 12 When two of them started go to the hospital for any others, most of the men are farmers convulsing, I ran to him and told reason because the head and some are traders. My husband him, he came and gave them more is one of the famers. The head of the of the herbal treatment, but still has different kinds of household is the eldest in the house there was no improvement. I herbs which he gives when and he controls all of us. begged him to let me take them to we are sick, so going to the the hospital but he refused. Two hospital is out of the The tradition in the house is, we are days later, there was still no not allowed to go to the hospital for improvement. question.” any reason because the head has different kinds of herbs which he After several days, people in the according to the family members, I gives when we are sick, so going to household pleaded with him, and am supposed to be strong as it was the hospital is out of the question. he then gave permission to take the will of God; they say “God gives them to the hospital. and God takes. It was later I One day I woke up and my 3 learned that they had malaria. Children were really ill, their bodies Unbelievably, and like a dream, one were very hot and they complained died as soon as we entered the They should have been taken to of high temperature, joint pains and hospital and the other two died 4 hospital immediately; the severe headache. These symptoms hours later. I was not allow to cry unnecessary delay by the head of have been recurring for over 3 over their death, because, the household led to their death. months at the time, but my brother 20 Paths2 In Motion

Mariya relives her ordeal in an interview with an Ask Kaduna researcher

My name is Mariya. I am 20 As soon as I arrived the hospital, he I asked his father for his years old. I have been married for 7 was put in the intensive care unit years. and the Doctor asked why I did not permission to take my bring my son early enough. I child to the hospital but he I have 4 children. I live in Wuciciri. explained to him that I did not get refused, saying “you only approval from my husband, and want to go and visit One of my children became ill, and that I had taken a tough decision for two weeks, he could not eat that day. friends and your family so anything apart from water and you will not go”... sometimes pap, He was losing Sadly, my child died 3 hours later weight and had high temperature that same day. and frequent diarrhea. ...I lost a child and also lost I took the corpse home only to find my marriage just because I I asked his father for his permission my husband waiting for me with a took my child to get to take my child to the hospital but divorce letter, I told him that our medical help. he refused, saying “you only want to child had died, and he only said ” go and visit friends and your family Allah ya ji kansa –meaning may his I have no regret for taking him to so you will not go”. soul rest in peace”. That didn’t stop the hospital even though it was him from giving me the divorce too late, but still if he had died at Several days later and with no sign letter. home, that would have been the of improvement, I took the bull by worse for me”. the horn and took him to the “I lost a child and also lost my hospital, ready to face my husband. marriage just because I took my child to get medical help. The roll out of the PATHS2 Ask Nigeria initiative has been the pivot for the successful execution of the Ask been a huge success with attendant testimonials, Nigeria community activities. Their solidarity for the initiation of joint community efforts among other Ask Nigeria process not only eased the entrance into things. These success stories were possible because of the communities, it emboldened the people to the support and the involvement of a wide range of interact freely with the team resulting in the voicing government and non government actors. of sincere health experiences.

Special thanks goes to the members of the Ask Nigeria The good people of Mpu, Ndeabor, Tundun Wada, teams in Enugu, Jigawa, Kaduna and Kano states for Wuciciri, Zaria, Shuarki, Yarkisi, Duru and Karnaya are their devotion to work and thirst for quality of work. appreciated for their warm reception and active Each team comprising of the media group, the participation in all the activities of the Ask Nigeria medical group, the civil society group and the process. undergraduates were the drivers of the process who worked tirelessly to ensure that each activity was The PATHS2 State Team Leaders (STLs) and Behavior implemented despite many challenges. Change Communication (BCC) officers in Enugu, Jigawa, Kaduna and Kano states are appreciated for For their unflinching support for the Ask Nigeria pilot their mobilization and coordination skills without process, the availability of their officers and the which the different stakeholders coupled with the permission to use some of their interventions as complex activities would not have been effectively platform for reaching the people, the Ministries of managed. Health of Enugu, Jigawa, Kaduna and Kano states are highly appreciated. Special thanks go to the health Commendation also goes to the PATHS2 Abuja educators at the state and local government levels. Communications Unit for providing technical oversight throughout the conceptualization and Being a bottom-up initiative, the traditional and execution of the Ask Nigeria process. religious leaders in the eight host communities have

Pictures courtesy of Ask Nigeria field teams in Enugu, Kaduna, Kano and Jigawa

Ask Nigeria pilot communities: Enugu (Mpu and Ndeaboh, Aniri LGA), Kaduna (Tundun Wada and Wuciciri, Zaria LGA), Kano (Shuarki and Yarkisi, Kunchi LGA), Jigawa (Duru and Karnaya, Dutse LGA)

National Team Leader for Ask Nigeria, Teena Iroegbu, with some Fulani women participants in Dutsen Duru Community at the Ask Jigawa Community Dialogue ABOUT PATHS2

The Partnership for Transforming Health Systems Phase Two (PATHS2) is a six year development initiative that aims to ensure Nigeria achieves important health-related Millennium Development Goals.

Funded by UKaid, through the UK’s Department of International Development, PATHS2 is working in partnership with the Government of Nigeria and other stakeholders, to improve the planning, financing and delivery of sustainable health services for those in most need. Apart from working at a Federal level, PATHS2 is working in the five States of Enugu, Jigawa, Kano, Kaduna and Lagos.

PATHS2 follows the successful PATHS1, which ran from 2002 to 2008, and was also funded by UKaid.

CONTACT PATHS2:

Mike Egboh National Programme Manager [email protected] 09-8725058

www.paths2.org

Federal Ministry of Health