Employing women as community health workers was a pretty radical change for conservative, predominantly Muslim areas of northern Nigeria.
Yet a small test using female community health workers revealed that Nigerian women and children were more likely to use health services if they could see women instead of male nurses.
Nigeria has one of the world’s highest death rates of women connected with pregnancy and childbirth — and northern Nigeria is worse off than most of the rest of the country. Male health workers travel from town to town, but many women patients won’t see a man for such personal issues.
One of the study's authors, Dr. Sally Findley, said the pilot study in Jigawa state required extensive community involvement and buy-in from religious leaders, even on such matters as transportation arrangements.
“We had to get permission from the state imam, the leader of all the Muslims in Jigawa, to have these female friendly motorcycles, and give permission for them to use them,” Findley noted.
A professor at Columbia University Medical Center of Population and Family Health and Sociomedical Sciences, Findley added, “Most women [there] are not expected to be living on their own, providing health care essentially 24/7 or riding around meeting with families in the scattered hamlets.”
The new women health workers were apparently a hit in their community. There were five times more visits to the health center after the women health workers arrived than before.
“In fact,” Findley commented, “they did like this, and it did change their understanding of what they could get if they went to the facility for care.”
What they could get included round-the-clock access to trained health workers, women who could handle normal births and refer complex cases to a hospital, and even assistance with family planning. Two health workers were assigned to a facility. That way, one could be out on home visits while the other was available to provide walk-in services.
The positive results of the Nigerian pilot study have prompted state officials in Jigawa to expand the program of women community health workers.
A paper describing the program by Sally Findley and her co-authors is published in the journal Global Health: Science and Practice.