When you are displaced from your home, accessing family planning services is probably the last thing on your mind. You will be more concerned with providing security, food and shelter for your family. This is the condition of most displaced families in Nigeria who were forced out of their homes to take refuge in other cities, thousands of kilometres away due to insecurity challenges. An estimated 2 million people in Nigeria are currently living away from their homes as a result of the insurgency in some parts of Northern Nigeria.
Many women living in internally displaced persons (IDP) camps face unwanted, unplanned and poorly spaced pregnancies. This is often caused by a lack of access to family planning services and supplies, non-existent or overburdened health facilities and providers with little time to educate them. Internally displaced persons are also at a higher risk of sexually transmitted infections (STIs), sexual abuse and gender-based violence.
The inhabitants of the Wassa IDP camp are no different. The camp is located in Wassa Village, a rural community in Nigeria’s Federal Capital Territory (FCT). With a population of about 5,572, the camp has households displaced from Borno, Adamawa, and Yobe States, all from the North-East of Nigeria. Nearly 70% of the population are children and young women of childbearing age, with most of them having given birth to more than six children before they turn 25. The COVID-19 pandemic further complicated the reproductive and general health challenges faced by the women and children in the IDP camps.
Collaborating for change
How do you work together to get internally displaced persons access to family planning services? Three organisations set out to address this problem by collaborating with each other and other organisations. Their efforts culminated in a one-day outreach on World Contraceptive Day 2020 (marked every September 26) to help members of the Wassa IDP camp to access family planning information and services at no cost. The organisations: Stand With a Girl Initiative (SWAG), Peach Aid Medical Initiative, and Sydani Initiative for International Development received support from the 120 under 40 ingenuity fund to execute the project as a consortium.
The fund invited previous winners of the 120 under 40 awards which recognises and celebrates reproductive health (RH) champions across the globe. They were tasked with sharing ideas on how to address both COVID-19 and the RH challenges in an integrated way — especially in the areas of advocacy, service delivery, communication/messaging and demand generation. Each organisation played a specific role for the project’s success and through that, showed that young people can successfully lead transformational RH initiatives.
SWAG leveraged on their advocacy and community engagement capacities to get the support of influential members of the community for the project. To sustain this support and to encourage ownership, they identified 14 community members who received special recognition as childbirth spacing champions. Another role they played involved providing soft grants to the community women and this provided an opportunity to access the women and girls to share sexual and reproductive health information.
Peach Aid also works in the area of providing reproductive health services. They provided menstrual cups to young women and girls in the camp and “the idea is to give them an innovative and hygienic way of managing their menstruation,” the founder, Nkasiobim Nebo said. They also provided birthing kits to pregnant women and free abdominal ultrasound scanning services for them. The women excitedly lined to be scanned as they learned the sex of their babies and listened as the providers gave them tips on healthy pregnancies.
For its part, Sydani Initiative led the monitoring and evaluation of the project to provide evidenced-based data for the duration of the project. “We have worked on the baseline assessment before the project and also ensuring there’s accurate representative data for all the sexual and reproductive health services rendered,” Adebisi Adenipekun, an Associate at Sydani Initiative said.
The consortium collaborated with other organisations that provided their unique capacities to strengthen the project. Breakthrough ACTION leveraged on their network of community mobilisers to inform the community members about the outreach. This effectively created demand and interest for the family planning information and services when the team arrived. Nearly 1000 men, women and young girls were already waiting before they arrived at the venue.
For Charles Salifu, Gimba Godfrey and Sule Jamila Idris, it is business as usual for them as they have been involved with community mobilisation since 2019. As local government supervisors, they support the volunteer community mobilisers stationed in various communities across the FCT. When there are major outreaches like the world contraceptive day event, they come from their assigned local governments to support.
To match the demand created through social mobilisation and advocacies, the consortium had two partners to support service provision. The Marie Stopes International and the FCT Primary Healthcare Board attended the outreach with experienced service providers to administer contraceptive services to desiring members of the community.
Beyond an outreach
Realising that reproductive health is an important issue in humanitarian situations, three United Nations agencies produced an inter-agency field manual to help in meeting this need. The manual states that the best way to guarantee that RH services meet the needs of displaced persons is to involve the community at every phase of the development of those services. The manual also recommends being sensitive to the religious and cultural practices of beneficiaries while emphasising that quality RH services must be based on the needs of displaced persons, particularly women. It also listed the principles for successful RH as adequate and well-trained staff, sufficient funding, effective community participation, quality care, integrated services, inclusion of information, education and
communication (IEC) activities, advocacy for RH and coordination among relief agencies.
The strategy adopted by the consortium adhered to the manual as they involved the community from the beginning and ensured their cultural and religious beliefs were respected. This informed their reason for referring to family planning as child spacing.
“The project strengthened community partnership to ensure women have access to sexual and reproductive health information and services,” says Margaret Bolaji, founder of SWAG.
Before the outreach day on September 26th, they identified and trained 14 community members who were officially recognised as child spacing champions. The service provider in the small camp clinic also received training to enable him to attend to women who may come back after receiving services to ask questions or follow up.
One of the champions, Usman Ibrahim, worked as a medical recorder at General Hospital Ngoshe, in Borno State, before being displaced. He now supervises an immunisation team for the Kabusa Ward in the Abuja Municipal Area Council (AMAC) of the FCT. The training equipped the champions to answer questions related to family planning and sustain the advocacy efforts in their communities. Bolaji and her consortium partners carefully selected the champions depending on how influential they were or their prior knowledge in the health sector.
Another champion, Lydia Haruna, said she strongly believes in the role family planning plays to drive development and better lives for their children. “Families with fewer children are likely to excel than those with many children. Our children are future presidents so we can’t let them be like us. Spacing them will make them healthier than when they are clustered,” she said. These are the messages she will be taking to other women in the community.
During the WCD outreach, the community members presented a drama to other community members. Laughter filled the air as the drama team made their presentations in Hausa with important messages that dispelled family myths and misconceptions. The team adopted this strategy to help drive home their messages about family planning to their community members.
At the end of the outreach, the team provided 22 different family planning methods. 210 women and girls received menstrual cups and learned safer and hygienic practices. 112 pregnant women also had abdominal ultrasound scans and received more information on the health status of their babies. 600 women of reproductive age received birthing kits for safe deliveries and 300 automatic thermometers were distributed to pregnant women and mothers with children under the age of 5.
Defying the odds
The challenge with one day medical outreaches is sustainability. Although the implementing organisations do great work providing services, and in some cases, diagnosing health conditions, they are not always around to follow up. But it appears the consortium designed the project with sustainability in mind by involving the community members from the beginning. This is better than rendering only outreach services. This helps strengthen health systems and builds structures that will sustain the gains of projects implemented.
For Adenipekun, the outreach is not the end of the project for his organisation as they are working on a mobile technology that will enable camp residents to access reproductive health information and services from their mobile devices.
Bolaji said training the Community Health Extension Worker (CHEW) who manages the camp’s three room clinic will help women who may have side effects after accessing services. They also provided referral cards to a primary health centre, about 2 km from the community.
She said that Nigeria’s task shifting and task sharing policy will empower CHEWs to provide family services to communities with little access. She reiterated the importance of designing projects with an inclusive community engagement component from the onset, to infuse community ownership and help ensure sustainability.