CHEWing over the options in Nigeria

I’ve just come back from northern Nigeria. The emphasis on northern is deliberate – Nigeria is a land of contrasts, and north versus south is perhaps the most significant.

The north, bordering the Sahel, is desert-dry, predominantly Muslim and conservative. The south is running down to the Atlantic, fertile, largely Christian and more modern. The contrast is equally stark when it comes to the health of the respective populations – northern Nigeria scores worse on almost all the significant indicators, including the key health Millennium Development Goals 4 (reducing child mortality) and 5 (reducing maternal mortality).

The map below is worth a thousand stats. Based on UNICEF data, its vivid traffic light colours show the rates of child deaths in each state in Nigeria. Needless to say, brilliant red is worse. On a map of Nigeria at least, bright northern lights do not make for attractive viewing.

Save the Children is part of a consortium of partners working in 4 states in northern Nigeria: Zamfara, Katsina, Jigawa and Yobe.

In collaboration with the state and district health authorities, our work is aimed at strengthening the health system and improving maternal, newborn and child health care.

One of the most significant challenges is trying to ensure that children, their mothers and others living in remote communities, far from the nearest health facility, are able to access health care services. We are looking at a number of options, in particular how Community Health Extension Workers (CHEWs) might be better utilised.

CHEWs are essential members of the Nigerian health workforce but are too often confined to health facilities rather than the communities they are intended to serve. There are many reasons for this, for example: a lack of higher-level facility-based staff likes nurses and midwives means that CHEWs have to cover for them. Also a factor is the lack of transport and inadequate training in the specific challenges of community-based work.

In partnership with the health authorities and, critically, in consultation with the communities, we’re developing a few innovative mini-projects aimed at overcoming these barriers. We’re hopeful that one or two will prove particularly effective in enabling people to access health care. If so, the next step would be to work with the health authorities to adapt their policies and to push for governments – state and federal in Nigeria as well as international donors – to increase the financial and human resources that will bring better health within the reach of many more neglected communities in Nigeria.